{ "hospital_name": "Northwestern Lake Forest Hospital DBA Northwestern Medicine Catherine Gratz Griffin Lake Forest Hospital", "last_updated_on": "2026-01-01", "version": "3.0.0", "location_name": [ "Northwestern Medicine Catherine Gratz Griffin Lake Forest Hospital", "Northwestern Medicine Grayslake" ], "hospital_address": [ "1000 N. Westmoreland Rd., Lake Forest, IL 60045", "1475 Belvidere Road, Grayslake, IL 60030" ], "license_information": { "license_number": "362179779001", "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": "Jeffrey Nacpil" }, "type_2_npi": [ "1124025176" ], "standard_charge_information": [ { "description": "1.5MM LOCKING SCREW SLF-TPNG WITH T4 STARDRIVE RECESS 7MM", "code_information": [ { "code": "SUP-377066", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 140.9, "maximum": 848.8, "setting": "outpatient", "gross_charge": 848.8, "discounted_cash": 594.16, "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 6.3% = $53.47 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 6.3% = $53.47 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 679.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 679.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 231.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 231.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 140.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 140.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 179.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 179.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 386.2, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 545.18, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 412.52, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 289.44, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 364.98, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 763.92, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 542.38, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 447.32, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 402.33, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 653.58, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 424.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $848.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $848.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 178.25, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 198.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 198.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 198.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "1.5MM LOK SCRW SLF-TPNG W T4 STARDRV RECESS 22MM", "code_information": [ { "code": "SUP-377069", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 140.9, "maximum": 848.8, "setting": "outpatient", "gross_charge": 848.8, "discounted_cash": 594.16, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 12.8% = $108.65 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 6.3% = $53.47 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $848.80 @ 6.3% = $53.47 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 198.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 424.4, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 364.98, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH PHCS", "standard_charge_dollar": 679.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 679.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 178.25, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 140.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 140.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 386.2, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 763.92, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 412.52, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 447.32, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 542.38, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 402.33, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 545.18, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 653.58, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 179.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 231.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 289.44, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $848.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $848.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 179.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 231.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 198.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 198.62, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 848.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 423.68, "10th_percentile": 140.15, "90th_percentile": 848.8, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "1.5MM TI CRTX SCRW ST 14MM", "code_information": [ { "code": "SUP-377162", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 47.39, "maximum": 285.51, "setting": "outpatient", "gross_charge": 285.51, "discounted_cash": 199.86, "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 6.3% = $17.99 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 6.3% = $17.99 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 228.41, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 228.41, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 77.94, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 77.94, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 47.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 47.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 60.5, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 60.5, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 129.91, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 183.38, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 138.76, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 97.36, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 122.77, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 256.96, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 182.44, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 150.46, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 135.33, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 219.84, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 142.76, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 285.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $285.51 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $285.51 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 285.51, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 59.96, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 66.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 66.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 66.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $285.51 @ 12.8% = $36.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 142.51, "10th_percentile": 47.15, "90th_percentile": 285.51, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "10 DEG ILIAC SCREW 6.5X80 TI", "code_information": [ { "code": "SUP-305537", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 967.81, "10th_percentile": 967.81, "90th_percentile": 1136.15, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 967.81, "10th_percentile": 967.81, "90th_percentile": 1136.15, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 967.81, "10th_percentile": 967.81, "90th_percentile": 1136.15, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "10 DEG ILIAC SCREW 8.5X55 TI", "code_information": [ { "code": "SUP-305554", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 967.81, "10th_percentile": 967.81, "90th_percentile": 1136.15, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 967.81, "10th_percentile": 967.81, "90th_percentile": 1136.15, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 967.81, "10th_percentile": 967.81, "90th_percentile": 1136.15, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "10F/5CM OASIS-STENT ERCP SYS OASIS SYS OACL-10-5 G25379", "code_information": [ { "code": "SUP-135132", "type": "CDM" }, { "code": "C2625", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 340.9, "maximum": 2053.6, "setting": "outpatient", "gross_charge": 2053.6, "discounted_cash": 1437.52, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2053.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,053.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,053.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 924.12, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1581.27, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1082.25, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 998.05, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1026.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1848.24, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1312.25, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 431.26, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 1319.03, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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 ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 700.28, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 973.41, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 934.39, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 883.05, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 435.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 435.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 340.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 340.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1642.88, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1642.88, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 560.63, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 560.63, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 480.54, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 480.54, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 480.54, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 12.8% = $262.86 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 6.3% = $129.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,053.60 @ 6.3% = $129.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 981.63, "10th_percentile": 323.86, "90th_percentile": 2053.6, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "12FRX40CM 0.038IN FLX CKFLO INTRO VASC BLKN RADPQ", "code_information": [ { "code": "SUP-139191", "type": "CDM" }, { "code": "C1894", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 85.69, "maximum": 516.21, "setting": "outpatient", "gross_charge": 516.21, "discounted_cash": 361.35, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 120.79, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 120.79, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 120.79, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 140.93, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 140.93, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 516.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $516.21 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $516.21 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 244.68, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 176.03, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 232.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 234.88, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 423.29, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 331.56, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH HFN PPO", "standard_charge_dollar": 464.59, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 108.4, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 250.88, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 329.86, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 221.97, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 258.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 272.04, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 85.69, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 85.69, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 412.97, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 412.97, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 109.38, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 109.38, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 12.8% = $66.07 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 6.3% = $32.52 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $516.21 @ 6.3% = $32.52 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 247.74, "10th_percentile": 247.74, "90th_percentile": 880.81, "count": "28", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "2.0MM DRILL BIT/JC/85MM (310.20)", "code_information": [ { "code": "SUP-15750", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 224.14, "maximum": 1350.26, "setting": "outpatient", "gross_charge": 1350.26, "discounted_cash": 945.18, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1350.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,350.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,350.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 607.62, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 283.01, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 368.76, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 297.19, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 314.21, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 286.12, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1080.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1080.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 224.14, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 224.14, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 656.23, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 1107.21, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 368.76, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 862.82, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 867.27, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 711.59, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 675.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 286.12, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 640.02, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1215.23, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 460.44, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 614.37, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 283.55, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 580.61, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 645.98, "10th_percentile": 645.98, "90th_percentile": 1350.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "2.0MM TI ELASTIC NAIL 440MM", "code_information": [ { "code": "SUP-22754", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 564.15, "maximum": 3398.5, "setting": "outpatient", "gross_charge": 3398.5, "discounted_cash": 2378.95, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 12.8% = $435.01 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 6.3% = $214.11 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,398.50 @ 6.3% = $214.11 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 795.25, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 795.25, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 795.25, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 927.79, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 927.79, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2718.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2718.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 720.14, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 720.14, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 564.15, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 564.15, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1158.89, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1699.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1461.36, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 713.69, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1546.32, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 3058.65, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1651.67, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1791.01, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2171.64, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1610.89, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2182.86, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2616.85, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3398.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,398.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,398.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3398.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1696.39, "10th_percentile": 488.29, "90th_percentile": 3398.5, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "2.0mm x 12mm Quick Fixe Cannulated Bone Screw", "code_information": [ { "code": "SUP-136133", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 174.67, "maximum": 1052.23, "setting": "outpatient", "gross_charge": 1052.23, "discounted_cash": 736.56, "payers_information": [ { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 6.3% = $66.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 6.3% = $66.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 287.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 174.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 675.85, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH AETNA", "standard_charge_dollar": 452.46, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 947.01, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 672.37, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 554.53, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 810.22, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 526.12, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1052.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 246.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 246.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 246.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 841.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 841.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 220.97, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 174.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 478.76, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 511.38, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 498.76, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS HMO", "standard_charge_dollar": 222.97, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 287.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 358.81, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1052.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,052.23 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,052.23 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 222.97, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" } ] } ] }, { "description": "2.4/2.7MM VA-LCP L-FUSION PLT LONG/RT", "code_information": [ { "code": "SUP-377062", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1112.65, "maximum": 6702.72, "setting": "outpatient", "gross_charge": 6702.72, "discounted_cash": 4691.9, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 5362.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 5362.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1829.84, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 1829.84, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1112.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1112.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1420.31, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1420.31, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3049.74, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 4305.16, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 3257.52, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 2285.63, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2882.17, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 6032.45, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4283.04, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3532.33, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 3177.09, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 5161.09, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3351.36, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6702.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $6,702.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $6,702.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 6702.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1407.57, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1568.44, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1568.44, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1568.44, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 12.8% = $857.95 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 6.3% = $422.27 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": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,702.72 @ 6.3% = $422.27 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3345.72, "10th_percentile": 868.94, "90th_percentile": 6702.72, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "2.7MM CORT SCR SELF-TAP SMALL HEX 32MM", "code_information": [ { "code": "SUP-353322", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 32.75, "maximum": 197.29, "setting": "outpatient", "gross_charge": 197.29, "discounted_cash": 138.1, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 157.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 157.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 53.86, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 53.86, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.75, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 95.88, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 41.43, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 6.3% = $12.43 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 6.3% = $12.43 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 84.83, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.75, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 89.77, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 177.56, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 103.97, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 126.07, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 93.52, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 126.72, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 151.91, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 67.28, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $197.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $197.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "2.7MM CORT SCR SELF-TAP SMALL HEX 48MM", "code_information": [ { "code": "SUP-353328", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 32.75, "maximum": 197.29, "setting": "outpatient", "gross_charge": 197.29, "discounted_cash": 138.1, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 157.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 157.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 53.86, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 53.86, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.75, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.75, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 89.77, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 126.72, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 95.88, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 67.28, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 84.83, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 177.56, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 126.07, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 103.97, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 93.52, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 151.91, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $197.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $197.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 41.43, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 46.17, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 6.3% = $12.43 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $197.29 @ 6.3% = $12.43 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.48, "10th_percentile": 32.57, "90th_percentile": 197.29, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "2.7MM CRTX SCRW ST 44MM", "code_information": [ { "code": "SUP-377126", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 44.83, "maximum": 270.07, "setting": "outpatient", "gross_charge": 270.07, "discounted_cash": 189.05, "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 6.3% = $17.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 6.3% = $17.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 216.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 44.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 44.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 57.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 57.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 173.47, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH AETNA", "standard_charge_dollar": 116.13, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 243.06, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 172.57, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 142.33, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 128.01, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 270.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $270.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $270.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 270.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 56.71, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 63.2, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $270.07 @ 12.8% = $34.57 due to $0.00 Claim Price" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 135.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 216.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 122.88, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 131.25, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 207.95, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 73.73, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 92.09, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 73.73, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 63.2, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 63.2, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 134.81, "10th_percentile": 44.59, "90th_percentile": 270.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "2.7MM LOCKING SCR TAP QC", "code_information": [ { "code": "SUP-353317", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 198.83, "maximum": 1197.79, "setting": "outpatient", "gross_charge": 1197.79, "discounted_cash": 838.45, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 958.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 958.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 327.0, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 327.0, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 198.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 198.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 253.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 253.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 544.99, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 769.34, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 582.13, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 408.45, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 515.05, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1078.01, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 765.39, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 631.24, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 567.75, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 922.3, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 598.9, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1197.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,197.79 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,197.79 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1197.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 251.54, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 280.28, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 280.28, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 280.28, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 12.8% = $153.32 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 6.3% = $75.46 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,197.79 @ 6.3% = $75.46 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 597.89, "10th_percentile": 197.78, "90th_percentile": 1197.79, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "20 DEG ILIAC SCREW 7.5X70 TI", "code_information": [ { "code": "SUP-107454", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 898.83, "maximum": 5414.61, "setting": "outpatient", "gross_charge": 5414.61, "discounted_cash": 3790.23, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 12.8% = $693.07 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 6.3% = $341.12 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": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,414.61 @ 6.3% = $341.12 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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1267.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1267.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1267.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1478.19, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 1478.19, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4331.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4331.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1147.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1147.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 898.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 898.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1846.38, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 4169.25, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2707.31, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2328.28, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1137.07, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2463.65, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 4873.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2631.5, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2853.5, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3459.94, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2566.53, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 3477.8, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5414.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $5,414.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $5,414.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5414.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 2702.75, "10th_percentile": 720.54, "90th_percentile": 5414.61, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "23GA SYSTEM END GRASPING FORCEPS", "code_information": [ { "code": "SUP-120364", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 189.23, "maximum": 1139.92, "setting": "outpatient", "gross_charge": 1139.92, "discounted_cash": 797.94, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1139.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,139.92 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,139.92 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 241.55, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 728.41, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 490.17, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 250.9, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 238.93, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 265.26, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 512.96, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 311.31, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 189.23, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 189.23, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 911.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 911.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 311.31, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 388.71, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 518.66, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 600.74, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 732.17, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 239.38, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 540.32, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 934.73, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 569.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1025.93, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 241.55, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 554.0, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 545.35, "10th_percentile": 545.35, "90th_percentile": 1139.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "23mm x 3.2cm x 105cm Commander Delivery System", "code_information": [ { "code": "SUP-379000", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 0.09, "setting": "outpatient", "gross_charge": 0.09, "discounted_cash": 0.06, "payers_information": [ { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 12.8% = $0.01 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 6.3% = $0.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.09 @ 6.3% = $0.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.02, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.02, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 0.02, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.01, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.01, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 0.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 0.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 0.04, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 0.04, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 0.05, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 0.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 0.04, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 0.04, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 0.05, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.02, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 0.06, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 0.06, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 0.07, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 0.08, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 0.03, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $0.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 0.04, "10th_percentile": 0.01, "90th_percentile": 0.09, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $0.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "25G DUAL BORE CANNULA", "code_information": [ { "code": "SUP-371596", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 66.67, "maximum": 401.6, "setting": "outpatient", "gross_charge": 401.6, "discounted_cash": 281.12, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 401.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $401.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $401.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 88.39, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 84.18, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 93.45, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 180.72, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 85.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 109.68, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 66.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 66.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 321.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 321.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 109.68, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 136.95, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 182.73, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 211.64, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 257.95, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 84.34, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 190.36, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 329.31, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 256.62, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 172.69, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 200.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 361.44, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 85.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 195.18, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 192.13, "10th_percentile": 192.13, "90th_percentile": 401.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "25G ILLUMINATED CURVED LASER PROBE", "code_information": [ { "code": "SUP-165158", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 314.84, "maximum": 1896.65, "setting": "outpatient", "gross_charge": 1896.65, "discounted_cash": 1327.65, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1896.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,896.65 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,896.65 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 417.45, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 397.54, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 441.35, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 853.49, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 401.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 517.98, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 314.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 314.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1517.32, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1517.32, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 517.98, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 646.76, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 862.98, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 999.53, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 1218.22, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 398.3, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 899.01, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 1555.25, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1211.96, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 815.56, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 948.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1706.99, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 401.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 921.77, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.38, "10th_percentile": 907.38, "90th_percentile": 1896.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.5MM CANN SCR FULL THD 48MM", "code_information": [ { "code": "SUP-353239", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 256.18, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 702.19, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 991.24, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 750.03, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 526.26, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 663.61, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1388.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 986.15, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 813.3, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 731.51, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 1188.32, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 324.09, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.5MM CANN SCR PARTIAL THD 22MM", "code_information": [ { "code": "SUP-353210", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 256.18, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 526.26, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 663.61, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 324.09, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 702.19, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1388.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 750.03, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 813.3, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 986.15, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 731.51, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 991.24, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1188.32, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "3.5MM CANN SCR PARTIAL THD 26MM", "code_information": [ { "code": "SUP-353214", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 256.18, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 702.19, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 750.03, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 526.26, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 663.61, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 813.3, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 731.51, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 324.09, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1188.32, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1388.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 986.15, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 991.24, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "3.5MM CANN SCREW PARTIAL THD 14MM", "code_information": [ { "code": "SUP-353455", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 256.18, "maximum": 1543.27, "setting": "outpatient", "gross_charge": 1543.27, "discounted_cash": 1080.29, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 421.31, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 702.19, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 991.24, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 750.03, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 526.26, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 663.61, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1388.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 986.15, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 813.3, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 731.51, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 1188.32, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 771.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 324.09, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 361.13, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,543.27 @ 6.3% = $97.23 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 770.34, "10th_percentile": 254.82, "90th_percentile": 1543.27, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.5MM COMPRESSION PLT 10 HLS 121MM", "code_information": [ { "code": "SUP-353393", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 174.67, "maximum": 1052.23, "setting": "outpatient", "gross_charge": 1052.23, "discounted_cash": 736.56, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 841.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 841.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 287.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 287.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 174.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 174.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 222.97, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 222.97, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 478.76, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 675.85, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 511.38, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 358.81, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 452.46, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 947.01, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 672.37, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 554.53, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 498.76, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 810.22, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 526.12, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1052.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,052.23 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,052.23 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1052.23, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 220.97, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 246.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 246.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 246.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 12.8% = $134.69 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 6.3% = $66.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,052.23 @ 6.3% = $66.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 525.23, "10th_percentile": 173.74, "90th_percentile": 1052.23, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.5MM COMPRESSION PLT 6 HLS 73MM", "code_information": [ { "code": "SUP-353384", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 160.12, "maximum": 964.55, "setting": "outpatient", "gross_charge": 964.55, "discounted_cash": 675.18, "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 6.3% = $60.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 6.3% = $60.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 771.64, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 263.32, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 263.32, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 160.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 204.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 468.77, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 414.76, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 508.32, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 457.2, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 482.28, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 964.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $964.55 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $964.55 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 225.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $964.55 @ 12.8% = $123.46 due to $0.00 Claim Price" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 771.64, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 202.56, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 160.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 438.87, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 868.1, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 616.35, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 619.53, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 742.7, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 328.91, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 204.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 225.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 225.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 964.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 481.46, "10th_percentile": 159.26, "90th_percentile": 964.55, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "3.5MM CORT SCR SELF-TAP SMALL HEX 10MM", "code_information": [ { "code": "SUP-353329", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 39.3, "maximum": 236.75, "setting": "outpatient", "gross_charge": 236.75, "discounted_cash": 165.72, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 6.3% = $14.92 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": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 6.3% = $14.92 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 55.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 55.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 55.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 64.63, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 64.63, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 189.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 189.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 50.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 50.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 39.3, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 39.3, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 80.73, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 118.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 101.8, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 49.72, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 107.72, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 213.08, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 115.06, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 124.77, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 151.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 112.22, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 152.06, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 182.3, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 236.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $236.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $236.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 236.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "3.5MM CORT SCR SELF-TAP SMALL HEX 65MM", "code_information": [ { "code": "SUP-353346", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 39.3, "maximum": 236.75, "setting": "outpatient", "gross_charge": 236.75, "discounted_cash": 165.72, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 12.8% = $30.30 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 55.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 55.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 55.4, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 64.63, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 64.63, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 189.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 189.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 50.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 50.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 39.3, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 39.3, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 80.73, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 182.3, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 6.3% = $14.92 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": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $236.75 @ 6.3% = $14.92 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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 118.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 101.8, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 49.72, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 107.72, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 213.08, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 115.06, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 124.77, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 151.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 112.22, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 152.06, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 236.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $236.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $236.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 236.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 118.18, "10th_percentile": 39.09, "90th_percentile": 236.75, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "3.5MM T-PLATE 4 HOLE HEAD 4 HOLE SHAFT 56MM", "code_information": [ { "code": "SUP-353523", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 138.28, "maximum": 833.02, "setting": "outpatient", "gross_charge": 833.02, "discounted_cash": 583.11, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 6.3% = $52.48 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $833.02 @ 6.3% = $52.48 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 194.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 194.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 194.93, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 227.41, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 227.41, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 666.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 666.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 176.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 176.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 138.28, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 138.28, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 284.06, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 641.43, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 416.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 358.2, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 174.93, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 379.02, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 749.72, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 404.85, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 439.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 532.3, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 394.85, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 535.05, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $833.02 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $833.02 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 415.81, "10th_percentile": 137.55, "90th_percentile": 833.02, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "3.5MM T-PLT 3 HL HEAD 3 HL SHAFT 50MM", "code_information": [ { "code": "SUP-353394", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 131.0, "maximum": 789.17, "setting": "outpatient", "gross_charge": 789.17, "discounted_cash": 552.42, "payers_information": [ { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 631.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 631.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 215.44, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 215.44, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 131.0, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 131.0, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 167.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 167.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 359.07, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 506.88, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 383.54, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 269.11, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 339.34, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 710.25, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 504.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 415.89, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 374.07, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 607.66, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 394.59, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 789.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $789.17 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $789.17 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 789.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 165.73, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 184.67, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 184.67, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 184.67, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 12.8% = $101.01 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 6.3% = $49.72 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $789.17 @ 6.3% = $49.72 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 393.92, "10th_percentile": 130.3, "90th_percentile": 789.17, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.7MM CANN LOK SCRW 10MM", "code_information": [ { "code": "SUP-377083", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 241.77, "maximum": 1456.46, "setting": "outpatient", "gross_charge": 1456.46, "discounted_cash": 1019.52, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 6.3% = $91.76 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": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 6.3% = $91.76 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 BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 340.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 340.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 340.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 397.61, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 397.61, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1165.17, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1165.17, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 308.62, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 308.62, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 241.77, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 241.77, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 496.65, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 728.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 626.28, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 305.86, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 662.69, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1310.81, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 707.84, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 767.55, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 930.68, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 690.36, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 935.48, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1121.47, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1456.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,456.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,456.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1456.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "3.7MM CANN LOK SCRW 12MM", "code_information": [ { "code": "SUP-377084", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 241.77, "maximum": 1456.46, "setting": "outpatient", "gross_charge": 1456.46, "discounted_cash": 1019.52, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 12.8% = $186.43 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 6.3% = $91.76 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": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,456.46 @ 6.3% = $91.76 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 BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 340.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 340.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 397.61, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 397.61, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1165.17, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 241.77, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 728.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 626.28, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH PHCS", "standard_charge_dollar": 1165.17, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 305.86, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 241.77, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 662.69, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1310.81, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 707.84, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 767.55, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 930.68, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 690.36, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 935.48, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1121.47, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 308.62, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 496.65, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1456.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,456.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,456.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 308.62, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 340.81, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1456.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 727.0, "10th_percentile": 240.49, "90th_percentile": 1456.46, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "30-34MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-115463", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 553.12, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1516.09, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2140.19, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1619.39, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1136.24, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1432.79, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2998.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1756.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1579.4, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2565.69, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 699.73, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "34-36MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-71583", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 553.12, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1432.79, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2998.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1756.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1136.24, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2565.69, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 699.73, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1516.09, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1619.39, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1579.4, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2140.19, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "36-39MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-800344", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 553.12, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1516.09, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2140.19, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1619.39, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1136.24, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1432.79, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2998.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1756.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1579.4, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2565.69, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 699.73, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.0MM CANC SCR SM HEX 30MM PARTIAL THD 14MM", "code_information": [ { "code": "SUP-353365", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 32.39, "maximum": 195.1, "setting": "outpatient", "gross_charge": 195.1, "discounted_cash": 136.57, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 156.08, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 156.08, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 53.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 53.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 88.77, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 125.31, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 94.82, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 66.53, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 83.89, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 175.59, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 124.67, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 102.82, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 92.48, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 150.23, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 97.55, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $195.10 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $195.10 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 40.97, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 45.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 45.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 45.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 6.3% = $12.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 6.3% = $12.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.0MM CANC SCR SMALL HEX 26MM FULLY THD", "code_information": [ { "code": "SUP-353360", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 32.39, "maximum": 195.1, "setting": "outpatient", "gross_charge": 195.1, "discounted_cash": 136.57, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 6.3% = $12.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $195.10 @ 6.3% = $12.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 45.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 45.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 45.65, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 53.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 53.26, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 156.08, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 156.08, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 41.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 32.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 66.53, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 150.23, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 97.55, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 83.89, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 40.97, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 88.77, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 175.59, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 94.82, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 102.82, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 124.67, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 92.48, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 125.31, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $195.10 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $195.10 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 97.39, "10th_percentile": 32.21, "90th_percentile": 195.1, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "4.0MM CANN SCRW-SHORT THRD 60MM", "code_information": [ { "code": "SUP-377133", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 181.95, "maximum": 1096.08, "setting": "outpatient", "gross_charge": 1096.08, "discounted_cash": 767.26, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 6.3% = $69.05 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": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,096.08 @ 6.3% = $69.05 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 BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 256.48, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 256.48, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 299.23, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 299.23, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH PHCS", "standard_charge_dollar": 876.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 232.26, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 232.26, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 181.95, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 373.76, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 256.48, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 548.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 471.31, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 876.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 230.18, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 181.95, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 498.72, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 986.47, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 532.69, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 577.63, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 700.4, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 519.54, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 704.01, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 843.98, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,096.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,096.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 547.12, "10th_percentile": 180.98, "90th_percentile": 1096.08, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "4.5MM CANNULATED SCREW PARTIALLY THREADED/30MM", "code_information": [ { "code": "SUP-31777", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 610.3, "maximum": 3676.53, "setting": "outpatient", "gross_charge": 3676.53, "discounted_cash": 2573.57, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2941.22, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2941.22, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1003.69, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 1003.69, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 610.3, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 610.3, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 779.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 779.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1672.82, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2361.44, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1786.79, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1253.7, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1580.91, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 3308.88, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2349.3, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1937.53, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1742.68, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2830.93, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1838.27, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3676.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,676.53 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,676.53 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3676.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 772.07, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 860.31, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 860.31, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 860.31, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 12.8% = $470.60 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 6.3% = $231.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,676.53 @ 6.3% = $231.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1835.17, "10th_percentile": 520.32, "90th_percentile": 3676.53, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "5.5 HEALIX TI ANCHR W OC NDLS", "code_information": [ { "code": "SUP-312479", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 435.22, "maximum": 2621.81, "setting": "outpatient", "gross_charge": 2621.81, "discounted_cash": 1835.27, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 435.22, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 435.22, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1192.92, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 894.04, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1242.74, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2018.79, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1310.91, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2621.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 613.5, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 613.5, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 613.5, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 715.75, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 715.75, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2097.45, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2097.45, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 555.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 555.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 12.8% = $335.59 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 6.3% = $165.17 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,621.81 @ 6.3% = $165.17 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1127.38, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 550.58, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2359.63, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1274.2, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1381.69, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1675.34, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1683.99, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2621.81, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,621.81 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1308.7, "10th_percentile": 398.81, "90th_percentile": 2621.81, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,621.81 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "5.5/6.35 CLS LAT CON 20MMTI", "code_information": [ { "code": "SUP-115168", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 553.12, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 699.73, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2565.69, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1756.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1432.79, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1619.39, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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 MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1579.4, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1499.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1516.09, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2140.19, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH HFN PPO", "standard_charge_dollar": 2998.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1136.24, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1592.74, "10th_percentile": 465.43, "90th_percentile": 3332.07, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "5.5CM THORACIC PLATE TI", "code_information": [ { "code": "SUP-306227", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1655.15, "10th_percentile": 1655.15, "90th_percentile": 1655.15, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "5.5MM X 24MM CANCELLOUS BONE SCREW", "code_information": [ { "code": "SUP-340980", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 145.56, "maximum": 876.86, "setting": "outpatient", "gross_charge": 876.86, "discounted_cash": 613.8, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 6.3% = $55.24 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 6.3% = $55.24 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 205.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 438.43, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 377.05, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH PHCS", "standard_charge_dollar": 701.49, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 701.49, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 184.14, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 145.56, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 145.56, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 398.97, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 789.17, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 426.15, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 462.11, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 560.31, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 415.63, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 563.21, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 675.18, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 185.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 239.38, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 299.01, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $876.86 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $876.86 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 185.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 239.38, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 205.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 205.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "58-80MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-115465", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 553.12, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1516.09, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1619.39, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1136.24, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1432.79, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2565.69, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 699.73, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2998.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1756.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1579.4, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2140.19, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" } ] } ] }, { "description": "5Fr MPA1 0.038\" x 125cm Diagnostic Catheter", "code_information": [ { "code": "SUP-314423", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 78.6, "maximum": 473.5, "setting": "outpatient", "gross_charge": 473.5, "discounted_cash": 331.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 473.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $473.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $473.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 104.22, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 99.25, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 110.18, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 213.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 100.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 129.31, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 78.6, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 78.6, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 378.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 378.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 129.31, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 161.46, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 215.44, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 249.53, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 304.13, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 99.44, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 224.44, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 388.27, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 302.57, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 203.61, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 236.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 426.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 100.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 230.12, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 473.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "6.5 X 40MM 3D EXT POST SCRW TI", "code_information": [ { "code": "SUP-57842", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 527.65, "maximum": 3178.62, "setting": "outpatient", "gross_charge": 3178.62, "discounted_cash": 2225.03, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 12.8% = $406.86 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 6.3% = $200.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,178.62 @ 6.3% = $200.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2542.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 867.76, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 867.76, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 527.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 673.55, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1446.27, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1544.81, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1675.13, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1589.31, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3178.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,178.62 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,178.62 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 743.8, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 743.8, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 743.8, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2542.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 673.55, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 527.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1083.91, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1366.81, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 667.51, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2860.76, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2031.14, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1506.67, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2041.63, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2447.54, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3178.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1586.63, "10th_percentile": 462.96, "90th_percentile": 3178.62, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" } ] } ] }, { "description": "6.5X45MM SCREW ATL TI", "code_information": [ { "code": "SUP-306243", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 414.84, "maximum": 2499.05, "setting": "outpatient", "gross_charge": 2499.05, "discounted_cash": 1749.33, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1999.24, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1999.24, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 682.24, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 682.24, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 414.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 414.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 529.55, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 529.55, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1137.07, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 1605.14, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1214.54, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 852.18, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1074.59, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2249.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1596.89, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1317.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1184.55, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 1924.27, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1249.53, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2499.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,499.05 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,499.05 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2499.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 524.8, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 584.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 584.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 584.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 12.8% = $319.88 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 6.3% = $157.44 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,499.05 @ 6.3% = $157.44 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1247.42, "10th_percentile": 384.67, "90th_percentile": 2499.05, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "6FR EBU 3.0 90CM LAUNCHER GUIDE CATHETER", "code_information": [ { "code": "SUP-333841", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 65.5, "maximum": 394.59, "setting": "outpatient", "gross_charge": 394.59, "discounted_cash": 276.21, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 92.33, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS HMO", "standard_charge_dollar": 83.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 83.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 65.5, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 107.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 107.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 134.56, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 252.14, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 355.13, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 394.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $394.59 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $394.59 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 207.95, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 323.56, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 187.04, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 177.57, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 191.77, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 197.3, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 253.45, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH AETNA ASA", "standard_charge_dollar": 179.54, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 169.67, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 82.86, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 65.5, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 315.67, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 315.67, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 92.33, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 92.33, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 12.8% = $50.51 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 6.3% = $24.86 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": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $394.59 @ 6.3% = $24.86 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 189.37, "10th_percentile": 66.39, "90th_percentile": 394.59, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "6Fr Guidezilla Guide Extension", "code_information": [ { "code": "SUP-354365", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 538.57, "maximum": 3244.38, "setting": "outpatient", "gross_charge": 3244.38, "discounted_cash": 2271.07, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 759.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 759.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 759.18, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 885.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 885.72, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2595.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2595.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 687.48, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 687.48, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 538.57, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 538.57, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1537.84, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1106.33, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1576.77, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1459.97, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1395.08, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1476.19, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1622.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 681.32, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2660.39, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1709.79, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2073.16, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2083.87, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH HFN PPO", "standard_charge_dollar": 2919.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3244.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,244.38 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,244.38 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 12.8% = $415.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 6.3% = $204.40 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,244.38 @ 6.3% = $204.40 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1557.06, "10th_percentile": 66.39, "90th_percentile": 3244.38, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "8CM THORACIC PLATE TI", "code_information": [ { "code": "SUP-306232", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1655.15, "10th_percentile": 1655.15, "90th_percentile": 1655.15, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $0.00 @ 6.3% = $0.00 due to $0.00 Claim Price Paid $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "8Fr x 100cm AL3 Guide Catheter", "code_information": [ { "code": "SUP-402777", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 62.59, "maximum": 377.05, "setting": "outpatient", "gross_charge": 377.05, "discounted_cash": 263.93, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 171.56, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 162.13, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 169.67, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 128.57, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 309.18, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 79.18, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 242.18, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 377.05, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $377.05 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $377.05 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 240.93, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 339.35, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 183.25, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 198.71, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 188.53, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 178.72, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH PHCS", "standard_charge_dollar": 301.64, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 301.64, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 79.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 79.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 62.59, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 62.59, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 102.93, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 102.93, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 88.23, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 88.23, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 88.23, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 12.8% = $48.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 6.3% = $23.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $377.05 @ 6.3% = $23.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.96, "10th_percentile": 66.39, "90th_percentile": 377.05, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ABDOMINAL BINDER 12IN", "code_information": [ { "code": "SUP-420212", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 9.98, "maximum": 60.15, "setting": "outpatient", "gross_charge": 60.15, "discounted_cash": 42.1, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 13.24, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 16.43, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 12.61, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 14.0, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 60.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $60.15 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $60.15 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 27.07, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 12.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.98, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.98, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 48.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 48.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 38.44, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 20.51, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 54.14, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 30.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 31.7, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 16.43, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 38.63, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC CORE", "standard_charge_dollar": 28.51, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 12.63, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 49.32, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 27.37, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 25.86, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS HMO", "standard_charge_dollar": 12.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 29.23, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 28.78, "10th_percentile": 28.78, "90th_percentile": 60.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ACETABULAR CUP POLY NEUTRAL ALTRX PINNACLE 40X68MM 0 DEG", "code_information": [ { "code": "SUP-375239", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 756.91, "maximum": 4559.67, "setting": "outpatient", "gross_charge": 4559.67, "discounted_cash": 3191.77, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1066.96, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1066.96, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1066.96, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 756.91, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 756.91, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4559.67, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,559.67 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $4,559.67 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 966.19, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1244.79, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4559.67, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3647.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1554.85, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1960.66, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2074.65, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2928.68, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3510.95, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2216.0, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS HMO", "standard_charge_dollar": 966.19, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1244.79, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2402.95, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 4103.7, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 957.53, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2279.84, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2161.28, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2913.63, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 6.3% = $287.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 6.3% = $287.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,559.67 @ 12.8% = $583.64 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3647.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2275.99, "10th_percentile": 690.79, "90th_percentile": 4559.67, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" } ] } ] }, { "description": "ACETAMINOPHEN 120 MG RECT SUPP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-103", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 6.3% = $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": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 30% = $0.68 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 30% = $0.68 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 30% = $0.68 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.25 @ 12.8% = $0.29 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_algorithm": "Service paid by fee schedule.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "OP High Cost Drugs; FSC: NM HB XR HEALTH ALLIANCE HCD AWP DRUG FSC, Value: 0.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_algorithm": "Service paid by fee schedule.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "OP High Cost Drugs; FSC: NM HB XR HEALTH ALLIANCE HCD AWP DRUG FSC, Value: 0.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_algorithm": "Service paid by fee schedule.", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "OP High Cost Drugs; FSC: NM HB XR HEALTH ALLIANCE HCD AWP DRUG FSC, Value: 0.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 0.99, "10th_percentile": 0.29, "90th_percentile": 1.8, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 95985.05, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_percentage": 16.6, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_percentage": 16.6, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 30.4, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 55.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_percentage": 72.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 86236.83, "10th_percentile": 22754.05, "90th_percentile": 120052.65, "count": "50", "methodology": "percent of total billed charges" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42767.2, "payers_information": [ { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Re-evaluated: HLB.467501616; Using new claim; Scope: All Financial Classes; Cases: 1; IP Services; 65% Billed", "median_amount": 30548.0, "10th_percentile": 10141.93, "90th_percentile": 50831.87, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Re-evaluated: HLB.467501616; Using new claim; Scope: All Financial Classes; Cases: 1; Inpatient Services; 50% Billed", "median_amount": 30548.0, "10th_percentile": 10141.93, "90th_percentile": 50831.87, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_percentage": 72.0, "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "median_amount": 30548.0, "10th_percentile": 10141.93, "90th_percentile": 50831.87, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_percentage": 16.6, "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "median_amount": 30548.0, "10th_percentile": 10141.93, "90th_percentile": 50831.87, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_percentage": 16.6, "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "median_amount": 30548.0, "10th_percentile": 10141.93, "90th_percentile": 50831.87, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "median_amount": 30548.0, "10th_percentile": 10141.93, "90th_percentile": 50831.87, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_percentage": 30.4, "standard_charge_algorithm": "Re-evaluated: HLB.467501616; Using new claim; Scope: All Financial Classes; Cases: 1; IP Services. ADP RATE (for patient estimates only); 30.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 30548.0, "10th_percentile": 10141.93, "90th_percentile": 50831.87, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "ADAPTER BRONCHOSCOPE EDGE SD300BA", "code_information": [ { "code": "SUP-369206", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 120.81, "maximum": 727.79, "setting": "outpatient", "gross_charge": 727.79, "discounted_cash": 509.45, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 198.76, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 160.19, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 582.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 120.81, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 353.71, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 198.76, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 363.9, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 152.84, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 727.79, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $727.79 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $727.79 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 152.54, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 169.36, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 327.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 154.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 120.81, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 582.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 248.18, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 331.14, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 383.55, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 467.46, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC CORE", "standard_charge_dollar": 344.97, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 596.79, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 465.06, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 312.95, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 655.01, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 154.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 348.18, "10th_percentile": 348.18, "90th_percentile": 727.79, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADAPTER PIN APEX LNG 3-6MM", "code_information": [ { "code": "SUP-358033", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 837.2, "maximum": 5043.39, "setting": "outpatient", "gross_charge": 5043.39, "discounted_cash": 3530.37, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5043.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $5,043.39 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $5,043.39 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2269.53, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1057.09, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1377.35, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1110.05, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1173.6, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1068.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4034.71, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4034.71, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 837.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 837.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2451.09, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 4135.58, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1377.35, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3222.73, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3239.37, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2657.87, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2521.7, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1068.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2390.57, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 4539.05, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1719.8, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2294.74, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1059.11, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2168.66, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2412.82, "10th_percentile": 2412.82, "90th_percentile": 5043.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADAPTOR DOUBLE MALE LUER LOCK (MX493)", "code_information": [ { "code": "SUP-14082", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1.29, "maximum": 7.8, "setting": "outpatient", "gross_charge": 7.8, "discounted_cash": 5.46, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $7.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $7.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.72, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.63, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.82, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2.13, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.29, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.29, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6.24, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6.24, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2.13, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 2.66, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3.55, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4.11, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 5.01, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.64, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 3.7, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 6.4, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4.98, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3.35, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3.9, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 7.02, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 3.79, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.73, "10th_percentile": 3.73, "90th_percentile": 7.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "RX-85043", "type": "CDM" }, { "code": "J0153", "type": "HCPCS" }, { "code": "0636", "type": "RC" } ], "standard_charges": [ { "minimum": 54.0, "maximum": 94.5, "setting": "outpatient", "gross_charge": 151.5, "discounted_cash": 106.05, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 6.3% = $9.54 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $151.50 @ 12.8% = $19.39 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'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_dollar": 94.5, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 54.00, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA LOCAL PLUS [178029]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_dollar": 68.04, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 48.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_dollar": 89.1, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 89.10, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "THE ALLIANCE [1703001]", "standard_charge_dollar": 54.0, "standard_charge_algorithm": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 54.00, and; Pricing Extension - NM HB 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": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 54.00, and; Pricing Extension - NM HB 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 30% = $45.45 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 30% = $45.45 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $151.50 @ 30% = $45.45 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $151.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $151.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 68.04, "10th_percentile": 19.39, "90th_percentile": 121.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "ADHESIVE VENASEAL VENOUS CLOSURE", "code_information": [ { "code": "SUP-373425", "type": "CDM" }, { "code": "C1760", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1338.41, "maximum": 8062.73, "setting": "outpatient", "gross_charge": 8062.73, "discounted_cash": 5643.91, "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 6.3% = $507.95 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 6.3% = $507.95 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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 MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,062.73 @ 12.8% = $1,032.03 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3628.23, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1338.41, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2201.13, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 2201.13, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 3918.49, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 4031.37, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6450.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6450.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3466.97, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 8062.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $8,062.73 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $8,062.73 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4249.06, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1708.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1708.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 7256.46, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 5152.08, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 5178.69, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1886.68, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1886.68, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 6208.3, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1338.41, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3821.73, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1886.68, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 2749.39, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3668.54, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1693.17, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3854.02, "10th_percentile": 1032.03, "90th_percentile": 8062.73, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "ADJ. CROSSLINK LARGE", "code_information": [ { "code": "SUP-112342", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 553.12, "maximum": 3332.07, "setting": "outpatient", "gross_charge": 3332.07, "discounted_cash": 2332.45, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 909.66, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 553.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1516.09, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 2140.19, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1619.39, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1136.24, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1432.79, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2998.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1756.0, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 1579.4, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2565.69, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1666.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 699.73, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 779.7, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,332.07 @ 6.3% = $209.92 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1663.23, "10th_percentile": 480.63, "90th_percentile": 3332.07, "count": "21", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADMIN SET EPIDRL MINI DRIP 60 GTT/ML 110IN LF W/O Y SITE", "code_information": [ { "code": "SUP-115352", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 5.1, "maximum": 30.72, "setting": "outpatient", "gross_charge": 30.72, "discounted_cash": 21.5, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 30.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $30.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $30.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 13.82, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6.44, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 8.39, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6.76, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 7.15, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 6.51, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 24.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 24.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.1, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.1, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 14.93, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 25.19, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 8.39, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 19.63, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 19.73, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 16.19, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 15.36, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 6.51, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 14.56, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 27.65, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 10.48, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 13.98, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 6.45, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 13.21, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.7, "10th_percentile": 14.7, "90th_percentile": 30.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADMIN SET IV BLD FLD WRM HI FLO TRAUM LEV 1 DISP", "code_information": [ { "code": "SUP-22912", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 245.46, "maximum": 1478.66, "setting": "outpatient", "gross_charge": 1478.66, "discounted_cash": 1035.06, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1478.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,478.66 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,478.66 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 665.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 309.93, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 403.82, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 325.45, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 344.08, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 313.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1182.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1182.93, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 245.46, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 245.46, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 718.63, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 1212.5, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 403.82, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 944.86, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 949.74, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 779.25, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 739.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 313.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 700.88, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1330.79, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 504.22, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 672.79, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 310.52, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 635.82, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 707.41, "10th_percentile": 707.41, "90th_percentile": 1478.66, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT HEAD FEM ENDOPROS VERSYS +10.5MM TIV", "code_information": [ { "code": "SUP-349723", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 145.56, "maximum": 876.86, "setting": "outpatient", "gross_charge": 876.86, "discounted_cash": 613.8, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $876.86 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $876.86 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 876.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 299.01, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 377.05, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 398.97, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 563.21, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 675.18, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 426.15, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 462.11, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 789.17, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 184.14, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 438.43, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 415.63, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 560.31, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 6.3% = $55.24 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 6.3% = $55.24 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $876.86 @ 12.8% = $112.24 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 205.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 205.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 205.19, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 145.56, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 145.56, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 239.38, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 239.38, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 701.49, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 701.49, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 185.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 185.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 437.69, "10th_percentile": 144.79, "90th_percentile": 876.86, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" } ] } ] }, { "description": "ADPT OFST DURAC STD 6MM COCR", "code_information": [ { "code": "SUP-58294", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1265.49, "maximum": 7623.42, "setting": "outpatient", "gross_charge": 7623.42, "discounted_cash": 5336.39, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $7,623.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $7,623.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 2599.59, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3278.07, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3468.66, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 4896.52, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5870.03, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 3704.98, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4017.54, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 6861.08, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1600.92, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3811.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3613.5, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4871.37, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 6.3% = $480.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 6.3% = $480.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1783.88, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1783.88, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1783.88, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1265.49, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1265.49, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2081.19, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 2081.19, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6098.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6098.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1615.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1615.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3805.29, "10th_percentile": 1043.74, "90th_percentile": 7623.42, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" } ] } ] }, { "description": "ADPT PERF CARDPLG M LL 2IN W/0.25IN BARB CONN", "code_information": [ { "code": "SUP-125367", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 5.11, "maximum": 30.78, "setting": "outpatient", "gross_charge": 30.78, "discounted_cash": 21.55, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 30.78, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $30.78 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $30.78 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 13.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6.45, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 8.41, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6.77, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 7.16, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 6.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 24.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 24.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.11, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.11, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 14.96, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 25.24, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 8.41, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 19.67, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 19.77, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 16.22, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 15.39, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 6.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 14.59, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 27.7, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 10.5, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 14.0, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 6.46, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 13.24, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.72, "10th_percentile": 14.72, "90th_percentile": 30.78, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT SLV FEM C TAPR V-40", "code_information": [ { "code": "SUP-119173", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 72.78, "maximum": 438.43, "setting": "outpatient", "gross_charge": 438.43, "discounted_cash": 306.9, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 102.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 102.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 102.59, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $438.43 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $438.43 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 280.16, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 281.6, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 219.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 438.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 231.05, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 207.82, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 394.59, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 213.08, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 199.49, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 149.5, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 92.07, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 188.52, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 337.59, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 119.69, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 119.69, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 72.78, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 72.78, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 350.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 350.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 92.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 92.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 12.8% = $56.12 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 6.3% = $27.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $438.43 @ 6.3% = $27.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 218.84, "10th_percentile": 72.39, "90th_percentile": 438.43, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT STK OSS SEG", "code_information": [ { "code": "SUP-149608", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 218.34, "maximum": 1315.29, "setting": "outpatient", "gross_charge": 1315.29, "discounted_cash": 920.7, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,315.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,315.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 448.51, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 565.57, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 598.46, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 844.81, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1012.77, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 639.23, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 693.16, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1183.76, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 276.21, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 657.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 623.45, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 840.47, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 12.8% = $168.36 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 6.3% = $82.86 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": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,315.29 @ 6.3% = $82.86 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 307.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 307.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 307.78, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 218.34, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 218.34, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 359.07, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 359.07, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1052.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1052.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 278.71, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 278.71, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 656.54, "10th_percentile": 217.18, "90th_percentile": 1315.29, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" } ] } ] }, { "description": "ADPT SWVL BRONCHSCP SUC", "code_information": [ { "code": "SUP-9048401", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 5.19, "maximum": 31.25, "setting": "outpatient", "gross_charge": 31.25, "discounted_cash": 21.87, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 31.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $31.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $31.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 14.06, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 6.55, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 8.53, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 6.88, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 7.27, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 6.62, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 25.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 25.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.19, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5.19, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 15.19, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 25.63, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 8.53, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 19.97, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 20.07, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 16.47, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 15.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 6.62, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 14.81, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 28.13, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 10.66, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 14.22, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 6.56, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 13.44, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.95, "10th_percentile": 14.95, "90th_percentile": 31.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT VLV HEMSTAS ENSNARE", "code_information": [ { "code": "SUP-131755", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 36.39, "maximum": 219.22, "setting": "outpatient", "gross_charge": 219.22, "discounted_cash": 153.45, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 219.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $219.22 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $219.22 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 48.25, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 45.95, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 51.01, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 98.65, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 46.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 59.87, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 36.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 36.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 175.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 175.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 59.87, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 74.75, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 99.75, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 115.53, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 140.81, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 46.04, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 103.91, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 179.76, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 140.08, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 94.26, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 109.61, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 197.3, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 46.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 106.54, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 104.88, "10th_percentile": 104.88, "90th_percentile": 219.22, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AGENT LIFTING 5ML SUBMUCOSAL ASCENDO STRL", "code_information": [ { "code": "SUP-425936", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 166.23, "maximum": 1001.38, "setting": "outpatient", "gross_charge": 1001.38, "discounted_cash": 700.97, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1001.38, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,001.38 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1,001.38 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 220.4, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 209.89, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 233.02, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 450.62, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 212.19, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 273.48, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 166.23, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 166.23, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 801.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 801.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 273.48, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 341.47, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 455.63, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 527.73, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 643.19, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 210.29, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 474.65, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 821.13, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 639.88, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 430.59, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 500.69, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 901.24, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 212.19, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 486.67, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 479.07, "10th_percentile": 479.07, "90th_percentile": 1001.38, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AIRWAY #0 CLEAR GUEDEL", "code_information": [ { "code": "SUP-308578", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1.93, "maximum": 11.62, "setting": "outpatient", "gross_charge": 11.62, "discounted_cash": 8.13, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 11.62, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $11.62 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $11.62 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5.23, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.44, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 3.17, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.56, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2.7, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 9.3, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 9.3, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.93, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.93, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 5.65, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 9.53, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 3.17, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 7.43, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 7.46, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 6.12, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 5.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 5.51, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 10.46, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 3.96, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 5.29, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2.44, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 5.0, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5.56, "10th_percentile": 5.56, "90th_percentile": 11.62, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AIRWAY BERMAN SZ4 90MM YELLOW PLAS NS DISP", "code_information": [ { "code": "SUP-424383", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 0.31, "maximum": 1.84, "setting": "outpatient", "gross_charge": 1.84, "discounted_cash": 1.29, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.4, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.31, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 0.92, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.31, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.5, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.39, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.5, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.43, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1.84 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $1.84 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 0.83, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 0.97, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1.18, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 0.63, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 0.89, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 1.66, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 0.84, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 0.79, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.39, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 1.18, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1.51, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 0.87, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.88, "90th_percentile": 1.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AIRWAY ESOPHAGEAL 3 LMA PROSEAL LARYNGEAL MASK HIGHER SEAL P", "code_information": [ { "code": "SUP-416357", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 487.62, "maximum": 2937.48, "setting": "outpatient", "gross_charge": 2937.48, "discounted_cash": 2056.24, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2937.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,937.48 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2,937.48 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1321.87, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 615.7, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 802.23, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 646.54, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 683.55, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 622.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2349.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2349.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 487.62, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 487.62, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1427.62, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 2408.73, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 802.23, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1877.05, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1886.74, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1548.05, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1468.74, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 622.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1392.37, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2643.73, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1001.68, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1336.55, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 616.87, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1263.12, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1405.32, "10th_percentile": 1405.32, "90th_percentile": 2937.48, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AIRWAY GUEDEL 50MM BLUE", "code_information": [ { "code": "SUP-337008", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 0.39, "maximum": 2.32, "setting": "outpatient", "gross_charge": 2.32, "discounted_cash": 1.62, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.32 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.32 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.49, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.63, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.51, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.54, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.39, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1.13, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 1.9, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.63, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1.48, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1.49, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1.22, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1.1, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 2.09, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 0.79, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1.06, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.49, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1.0, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.11, "10th_percentile": 1.11, "90th_percentile": 2.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AIRWY MSK FLEX LMA SZ 2.0 DISP", "code_information": [ { "code": "SUP-313720", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 28.38, "maximum": 170.99, "setting": "outpatient", "gross_charge": 170.99, "discounted_cash": 119.69, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 170.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $170.99 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $170.99 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 37.63, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 35.84, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 39.79, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 76.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 36.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 46.7, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 28.38, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 28.38, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 136.79, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 136.79, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 46.7, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 58.31, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 77.8, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 90.11, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 109.83, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 35.91, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 81.05, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 140.21, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 109.26, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 73.53, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 85.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 153.89, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 36.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 83.1, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 170.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.8, "10th_percentile": 81.8, "90th_percentile": 170.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AIRWY OP FLX GUEDL CATH GUID 55MM SZ 5.5 LF NS", "code_information": [ { "code": "SUP-2666", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 0.95, "maximum": 5.75, "setting": "outpatient", "gross_charge": 5.75, "discounted_cash": 4.02, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $5.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $5.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.21, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1.57, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.27, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1.34, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.95, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2.79, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 4.72, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1.57, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3.67, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3.69, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3.03, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2.73, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 5.18, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 1.96, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2.62, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.21, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2.47, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.95, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.75, "10th_percentile": 2.75, "90th_percentile": 5.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INH NEBU", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-250", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0250", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 30% = $0.60 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 30% = $0.60 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 30% = $0.60 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2.00 @ 6.3% = $0.13 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 0.88, "10th_percentile": 0.26, "90th_percentile": 1.6, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price" } ] } ] }, { "description": "ALLOGRAFT MS 8CMX16CMX0.3MM BMTRX THCK", "code_information": [ { "code": "SUP-432141", "type": "CDM" }, { "code": "Q4100", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2139.71, "maximum": 12889.84, "setting": "outpatient", "gross_charge": 12889.84, "discounted_cash": 9022.89, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3016.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3016.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 3016.22, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 3518.93, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 3518.93, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2139.71, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2139.71, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2731.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2731.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 10311.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 10311.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 6109.78, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 4395.44, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 8236.61, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 5864.88, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 6444.92, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 6792.95, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 5542.63, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 11600.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 9925.18, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 8279.14, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2706.87, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 6264.46, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 12889.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $12,889.84 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $12,889.84 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5800.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 12.8% = $1,649.90 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 6.3% = $812.06 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": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,889.84 @ 6.3% = $812.06 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6161.39, "10th_percentile": 1649.9, "90th_percentile": 12889.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMBU / RESUSCITATOR BAG W/MASK", "code_information": [ { "code": "SUP-300940", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 34.2, "maximum": 206.03, "setting": "outpatient", "gross_charge": 206.03, "discounted_cash": 144.22, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 206.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $206.03 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $206.03 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 45.35, "standard_charge_percentage": 22.01, "standard_charge_algorithm": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 22.01% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 22.01% OF CHARGES; Note: Paid 22.01% of billed, which is the lesser of contractual rate and 22.01% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 43.18, "standard_charge_percentage": 20.96, "standard_charge_algorithm": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 20.96% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 20.96% OF CHARGES; Note: Paid 20.96% of billed, which is the lesser of contractual rate and 20.96% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 47.94, "standard_charge_percentage": 23.27, "standard_charge_algorithm": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 23.27% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 23.27% OF CHARGES; Note: Paid 23.27% of billed, which is the lesser of contractual rate and 23.27% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 92.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 43.66, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 56.27, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 34.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 34.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 164.82, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 164.82, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 56.27, "standard_charge_percentage": 27.31, "standard_charge_algorithm": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 27.31% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 27.31% OF CHARGES; Note: Paid 27.31% of billed, which is the lesser of contractual rate and 27.31% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 70.26, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 93.74, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC HMO/PPO", "standard_charge_dollar": 108.58, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH THE ALLIANCE", "standard_charge_dollar": 132.33, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 43.27, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 97.66, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 168.94, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 131.65, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 88.59, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 103.02, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 185.43, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 43.66, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 100.13, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "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": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 98.57, "10th_percentile": 98.57, "90th_percentile": 206.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMIKACIN 250 MG/ML INJ SOLN", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "RX-183748", "type": "CDM" }, { "code": "J0278", "type": "HCPCS" }, { "code": "0636", "type": "RC" } ], "standard_charges": [ { "minimum": 4.15, "maximum": 7.26, "setting": "outpatient", "gross_charge": 27.75, "discounted_cash": 19.42, "payers_information": [ { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_dollar": 4.15, "standard_charge_algorithm": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 4.15, and; Pricing Extension - NM HB 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": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 4.15, and; Pricing Extension - NM HB 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": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_dollar": 7.26, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 4.15, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA GENERIC [178031]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_dollar": 6.58, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 4.70, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_dollar": 6.85, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 6.85, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 6.3% = $1.75 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 30% = $8.33 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 30% = $8.33 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 30% = $8.33 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $27.75 @ 12.8% = $3.55 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP; 82% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP; 82% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP; 82% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 82% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $27.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $27.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 6.85, "10th_percentile": 3.55, "90th_percentile": 22.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "AMILORIDE 5 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-391", "type": "CDM" }, { "code": "63700000", "type": "HCPCS" }, { "code": "0637", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "No historical claim; Outpatient Services; 50% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Procedures; 65% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Procedures; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Other OP; 65% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "No historical claim; OP Procedure; 56.5% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Procedure; 56.5% Billed" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "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": "GLOBAL EXCEL [171201]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "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": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Procedures; 45% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedures; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; IPA OP Services; 45% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "AMINOCAPROIC ACID 250 MG/ML IV SOLN", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "RX-403", "type": "CDM" }, { "code": "25000000", "type": "HCPCS" }, { "code": "0250", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.25, "discounted_cash": 20.47, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $29.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $29.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Procedures; 45% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedures; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; IPA OP Services; 45% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; IPA OP Services; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "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": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "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": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Other OP; 65% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Procedures; 65% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Procedures; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "No historical claim; OP Procedure; 56.5% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "No historical claim; Outpatient Services; 50% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 23.4, "10th_percentile": 12.9, "90th_percentile": 29.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" } ] } ] }, { "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" } ], "standard_charges": [ { "minimum": 27.44, "maximum": 53.4, "setting": "outpatient", "gross_charge": 226.25, "discounted_cash": 158.37, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 6.3% = $14.25 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $226.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $226.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA ONE HEALTH [178036]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_dollar": 27.44, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 19.60, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_dollar": 40.34, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 23.05, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_dollar": 53.4, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 53.40, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 30% = $67.88 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 30% = $67.88 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 30% = $67.88 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $226.25 @ 12.8% = $28.96 due to $0.00 Claim Price" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 45.51, "10th_percentile": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 27.44, "90th_percentile": 181.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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 360 MG/200 ML (1.8 MG/ML) IV SOLN", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "RX-191198", "type": "CDM" }, { "code": "J0283", "type": "HCPCS" }, { "code": "0636", "type": "RC" } ], "standard_charges": [ { "minimum": 65.86, "maximum": 128.16, "setting": "outpatient", "gross_charge": 301.75, "discounted_cash": 211.22, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 30% = $90.53 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 30% = $90.53 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 30% = $90.53 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Other OP; 65% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $301.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $301.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_dollar": 96.81, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 55.32, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_dollar": 128.16, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 128.16, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_dollar": 65.86, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 47.04, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 6.3% = $19.01 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $301.75 @ 12.8% = $38.62 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 96.81, "10th_percentile": 38.62, "90th_percentile": 241.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" } ] } ] }, { "description": "AMOXICILLIN 250 MG/5 ML ORAL SUSR", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-454", "type": "CDM" }, { "code": "63700000", "type": "HCPCS" }, { "code": "0637", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.5, "discounted_cash": 11.55, "payers_information": [ { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "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": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "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": "GLOBAL EXCEL [171201]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "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": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "No historical claim; OP Procedure; 56.5% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Procedure; 56.5% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Other OP; 65% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Procedures; 65% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Procedures; 65% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "No historical claim; Outpatient Services; 50% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Procedures; 45% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedures; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; IPA OP Services; 45% Billed", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $16.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $16.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13.2, "10th_percentile": 7.28, "90th_percentile": 16.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "AMOXICILLIN 500 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-451", "type": "CDM" }, { "code": "63700000", "type": "HCPCS" }, { "code": "0637", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "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": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "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": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "No historical claim; Outpatient Services; 50% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Procedures; 45% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedures; 45% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "No historical claim; OP Procedure; 56.5% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Procedure; 56.5% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Other OP; 65% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 65% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Procedures; 65% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Procedures; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; IPA OP Services; 45% Billed", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; IPA OP Services; 45% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.6, "10th_percentile": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 0.88, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "AMOXICILLIN-POT CLAVULANATE 1,000-62.5 MG ORAL TB12", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-33862", "type": "CDM" }, { "code": "63700000", "type": "HCPCS" }, { "code": "0637", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.0, "discounted_cash": 25.9, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "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": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "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": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $37.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $37.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "No historical claim; Outpatient Services; 50% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; IPA OP Services; 45% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; IPA OP Services; 45% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Procedures; 65% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Procedures; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Other OP; 65% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "No historical claim; OP Procedure; 56.5% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Procedure; 56.5% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Procedures; 45% Billed", "median_amount": 29.6, "10th_percentile": 16.32, "90th_percentile": 37.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedures; 45% Billed" } ] } ] }, { "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": "HCPCS" }, { "code": "0637", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.25, "discounted_cash": 1.57, "payers_information": [ { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "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": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "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": "GLOBAL EXCEL [171201]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "No historical claim; Outpatient Services; 50% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Outpatient Services; 50% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "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": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "No historical claim; All Other Procedure; 80% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedure; 80% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_percentage": 54.1, "standard_charge_algorithm": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 54.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_percentage": 44.1, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 44.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_percentage": 53.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 53.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 25.8, "standard_charge_algorithm": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 25.8% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 25.8% OF CHARGES; Note: Paid 25.8% of billed, which is the lesser of contractual rate and 25.8% of charges." }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "No historical claim; All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "UHC ALL SAVERS CORE [158070]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_percentage": 48.8, "standard_charge_algorithm": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; Table 5 Services; 48.8% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "No historical claim; OP Services; 22.4% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Services; 22.4% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 21.7, "standard_charge_algorithm": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 21.7% Billed, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 21.7% OF CHARGES; Note: Paid 21.7% of billed, which is the lesser of contractual rate and 21.7% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA HMO [178002]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_percentage": 22.2, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 22.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Procedures; 65% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Procedures; 65% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "No historical claim; All Other OP; 65% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 65% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; IPA OP Services; 45% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; IPA OP Services; 45% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "No historical claim; OP Procedure; 56.5% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP Procedure; 56.5% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "No historical claim; All Other Procedures; 45% Billed", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other Procedures; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1.8, "10th_percentile": 0.99, "90th_percentile": 2.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $2.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "AMPICILLIN SODIUM 500 MG INJ SOLR", "drug_information": { "unit": 500.0, "type": "ME" }, "code_information": [ { "code": "RX-474", "type": "CDM" }, { "code": "J0290", "type": "HCPCS" }, { "code": "0636", "type": "RC" } ], "standard_charges": [ { "minimum": 1.01, "maximum": 1.77, "setting": "outpatient", "gross_charge": 6.0, "discounted_cash": 4.2, "payers_information": [ { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 30% = $1.80 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 30% = $1.80 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 30% = $1.80 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_dollar": 1.01, "standard_charge_algorithm": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 1.01, and; Pricing Extension - NM HB 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": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 1.01, and; Pricing Extension - NM HB 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": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA POS [178008]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.01, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA GENERIC [178031]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_dollar": 1.33, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 0.95, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_dollar": 1.67, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 1.67, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 6.3% = $0.38 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6.00 @ 12.8% = $0.77 due to $0.00 Claim Price" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $6.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $6.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 1.67, "10th_percentile": 0.77, "90th_percentile": 4.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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 1.5 G INJ SOLR", "drug_information": { "unit": 1500.0, "type": "ME" }, "code_information": [ { "code": "RX-27282", "type": "CDM" }, { "code": "J0295", "type": "HCPCS" }, { "code": "0636", "type": "RC" } ], "standard_charges": [ { "minimum": 1.77, "maximum": 3.1, "setting": "outpatient", "gross_charge": 10.0, "discounted_cash": 7.0, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "GLOBAL EXCEL [171201]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "ALTERNATE MEDICARE LOC PART B ONLY [241701]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "ALTERNATE MEDICARE IMMUNIZATION BILLING [201101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOSPICE - GENERIC [601002]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "ACCENTCARE HOSPICE [601008]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "JOURNEYCARE HOSPICE (ADDUS) BARRINGTON [601110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "TRANSITIONS HOSPICE [601009]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HARBOR LIGHT HOSPICE [601007]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE BEHAVIORAL HEALTH [160106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-NEXT LEVEL [160107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "AETNA BETTER HEALTH OF IL [160109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN HEALTH PLAN OF IL [160111]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "BLUE CROSS COMMUNITY [160117]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "IL REPLACEMENT GENERIC [160120]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-HARMONY HEALTH PLAN [160121]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "MOLINA HEALTHCARE [160122]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "X-ILLINICARE/CENPATICO BEHAVIORAL HEALTH [160123]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE [160124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "YOUTHCARE IL [160129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "OPTUM MEDICAID REPL (TRANSPLANT) [160133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "COUNTYCARE IMMIGRANT HBIA-HBIS [160136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "MERIDIAN IMMIGRANT HBIA-HBIS [160138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICAID REPLACEMENT [1601]", "plan_name": "BC COMMUNITY IMMIGRANT HBIA/S [160137]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 6.3% = $0.63 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": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX HMO [130136]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA NMPN SITE 757 PPO/HMO/HMO-POS [130188]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA HMO [130197]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA IL/MT/NM/OK/TX PPO [130138]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA HMO [130124]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA PPO [1301106]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE HMO - GENERIC [1301105]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "DEVOTED HEALTH IPA MA HMO ADVOCATE [1301104]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA BETTER HEALTH PREMIER MMAI [130144]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "OPTUM MA (TRANSPLANT) [1301100]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA MA PPO [130139]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA HMO OUT OF STATE [130186]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COVENTRY MA PPO [130140]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS MA PPO OUT OF STATE [130185]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA HMO [130183]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "CIGNA MA PPO [130182]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MVP HEALTHCARE [130181]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "SECURE HORIZONS DIRECT [130180]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA COMMUNITY SELECT HMO [1301103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA C-SNP HMO [1301101]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PROVIDER PARTNERS HLTH PLN IL MA HMO [1301102]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA FOX VALLEY PPO/HMO/HMO-POS [130154]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA LOYOLA PP (CHS) [130155]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA LOYOLA PP (CHS) [130158]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "AETNA IPA MA ADVOCATE AMG [130171]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA IPA MA ADVOCATE [130172]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTHSPRING IPA MA ADVOCATE AMG [130174]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE PPO-GENERIC [130179]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP FOCUS/COMPLETE CARE HMO [130134]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MMAI [130196]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA/AARP IL-001P HMO [130178]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP HMO [130133]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HEALTH ALLIANCE MA [130150]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MMAI [1301110]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 30% = $3.00 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA PPO [1301109]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 30% = $3.00 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "ZING HEALTH MA HMO/HMO-POS [1301107]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN AT 30% & HAS APC & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 30% = $3.00 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE [140138]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO ADVOCATE DREYER [140139]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "X-HUMANA IPA HMO ADVOCATE AMG [130019]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BCBS COMMUNITY MMAI [130137]", "standard_charge_percentage": 93.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 93% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 93% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE/SELECT/PREFERRED [140128]", "standard_charge_percentage": 24.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS BLUE CHOICE OPTIONS [140123]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS CTY EMPLOYEES [140142]", "standard_charge_percentage": 24.2, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 24.2% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS 121 HMO [140201]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BC PRECISION HMO [140203]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO GENERIC [140137]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE HMO [140166]", "standard_charge_percentage": 22.4, "standard_charge_algorithm": "OP Services; 22.4% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 22.4% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "ALTERNATE BLUE CROSS 121 PPO [140202]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS OF ILLINOIS PPO [140104]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS - OUT OF STATE PPO [140126]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS SEIU GRP PH4964 [140153]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS UHS PPO [140154]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS FEP PPO [140167]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS LIMITED BENEFITS [140160]", "standard_charge_percentage": 29.1, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 29.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "X-BEECHSTREET/GETTYSBURG HEALTH [176013]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/GLOBAL CARE [176024]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/MEGA LIFE & HLTH [176046]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/CHEC/WEBTPA [176022]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/TRUSTMARK [142107]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRAIRIE STATES [142047]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/INSURERS ADMIN [142044]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PRIORITY HEALTH [142048]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/GROUP HEALTH [142101]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PEKIN [142110]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS TPA GENERIC [142167]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HARVARD PILGRIM [142097]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS KEY BENEFITS [142133]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHC/WEBTPA [142126]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SAGAMORE HEALTH [142089]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/PBA [142077]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/NIPPON LIFE [142072]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SISCO [142071]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/DIVERSIFIED ADMIN [142063]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MEDICAL MUTUAL OH [142119]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GROUP ADMIN LTD [142121]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CORESOURCE [142059]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/BAS [142058]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/BAS [142009]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "THE ALLIANCE [1703001]", "standard_charge_dollar": 1.77, "standard_charge_algorithm": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 1.77, and; Pricing Extension - NM HB 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": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Lab & Drug Services; FSC: NM HB XR THE ALLIANCE LAB & DRUG SERVICES, Value: 1.77, and; Pricing Extension - NM HB 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": "AETNA ILLINOIS PREFERRED HMO/EPO [171121]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA PPO [171003]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT HMO/POS [171020]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA POS [171031]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HMO/EC/SELECT [171045]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA/NIU STUDENT HEALTH [171050]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN HEALTH PPO [171062]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN POS [171065]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS HMO [171087]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ILLINOIS PREFERRED CHOICE POS II [171098]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STATE OF ILLINOIS-OAP/QCHP [171100]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA OPEN ACCESS [171102]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA STUDENT HEALTH [171103]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AEXCEL PLUS CHOICE POS II [171106]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA \ufffd APCN/SAVINGS PLUS [171109]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "CIGNA-SPRAYING SYSTEM [178034]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLEGIANCE [178039]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA POS [178008]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GW PPO [178006]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ALLIED BENEFIT [178035]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA GENERIC [178031]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PRIORITY HEALTH [178041]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA NU VISITING SCHOLAR [178043]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA TRUSTMARK PPO [178044]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HMO [178002]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA LOCAL PLUS [178029]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ONE HEALTH [178036]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA HEALTHPARTNERS/OA PLUS [178015]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA PPO [178005]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA MVP HEALTH CARE [178028]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA/TUFTS HEALTH PLAN OA PLUS [178027]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA INTERNATIONAL [178026]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA OPEN ACCESS/OA PLUS [178011]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "CIGNA ULINE [178032]", "standard_charge_dollar": 2.87, "standard_charge_algorithm": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Injectable Drugs; 140% of FSC: NM HB XR CIGNA MARKET FEE SCHEDULE INJECTABLE DRUGS, Value: 2.05, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CORE [158070]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH CORE [158081]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CORE [158058]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NAVIGATE [158061]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "X-UHC A T & T GROUP [158048]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MAILHANDLERS BENEFITS [158049]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC TPA GENERIC [158051]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SELECT/CHOICE PLUS/EPO/POS [158047]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OF RIVER VALLEY [158046]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC PPO [158027]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR PPO [158019]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR CORE [158074]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC GOLDEN RULE [158018]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC OXFORD HEALTH [158016]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HMO [158012]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR ADVOCATE AURORA SCT [158080]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO OA/OAP [158075]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC HEALTHSCOPE CHOICE PLUS [158073]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC LIMITED BENEFITS GENERIC [158072]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SUREST [158071]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC CATERPILLAR NETWORK [158067]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC NEXUS ACO [158066]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC MEDICA [158065]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS CHOICE PLUS [158063]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC UMR HMO POS [158004]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC SHARED SERVICES [158062]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC STUDENT RESOURCES PPO [158052]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "UHC ALL SAVERS NAVIGATE HMO [158077]", "standard_charge_dollar": 2.92, "standard_charge_algorithm": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "High Cost Drugs; FSC: NM HB XR UHC DRUG FSC 38910, Value: 2.92, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN APCN [171111]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA MERITAIN IL PREFERRED [171114]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA BP CHOICE POS [171116]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CVS HEALTH QHP/PPO EXCHANGE [171120]", "standard_charge_dollar": 3.1, "standard_charge_algorithm": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Drugs/Agents; 175% of FSC: NM HB AETNA DRUG FEE SCHEDULE, Value: 1.77, and; Pricing Extension - HB XR PRC - LESSER OF TERMS OR CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 100% of charges." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE [130020]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO ADVOCATE DREYER [130018]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "X-BC IPA HMO ADVOCATE AMG [140145]", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 120% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 120% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "HOME BOUND HOSPICE [601004]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "RAINBOW HOSPICE [601003]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "VITAS HOSPICE [601005]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "DEKALB COUNTY HOSPICE [601011]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "PRIORITY HEALTH MA HMO [130103]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE MA HMO [130128]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMERCIAL MMAI MEDICARE - GENERIC [130129]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA PFFS [130131]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG (IHP) [130153]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "COMMUNITY CARE ALLIANCE MA [130148]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MERIDIAN COMPLETE MMAI OF IL [130145]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MOLINA HEALTHCARE MMAI [130195]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ENDEAVOR [130193]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DMG SITE 745 [130191]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "MEDICARE ADVANTAGE IPA - GENERIC [130190]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA ADVOCATE [130164]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "BC IPA MA DREYER ADVOCATE [130165]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "WELLCARE IPA MA ADVOCATE AMG [130170]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA HMO [130135]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "UHC MA / AARP PPO [130132]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "HUMANA MA PPO [130125]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Paid as a percent of APC rate.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NM HB XR PRC - 3M $0 RETURN & HAS APC FOR NLFH & LESSOR OF; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10.00 @ 12.8% = $1.28 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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": "MULTIPLAN TPA GENERIC [142166]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/KLAIS [142010]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/OPTIMED HEALTH PLAN [142016]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ADMIN CONCEPTS [142021]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ARKANSAS BEST [142026]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "MULTIPLAN PHCS/SIHO [142039]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/GLOBAL CARE [142049]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/EBMS [142043]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "X-PHCS/SAVILITY [142042]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS MERITAIN HEALTH 853921 [142165]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/CHRISTIAN BROTHERS EMP BENEFIT TRUST [142160]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS ALLIED BENEFIT [142117]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/MERITAIN HEALTH [142156]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/HEALTH EZ LIFETIME [142154]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/COORDINATED BENEFITS [142143]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "PHCS/ASR HEALTH BENEFITS [142142]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "BEECHSTREET/HEALTHSMART PREF [176032]", "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/DART MEMBER CARE [126012]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN TPA GENERIC [126023]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 10 PPO [126005]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN 20 EPO [126020]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "X-HFN HEALTH ALLIANCE [126007]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN/TRANSCHOICE-KEY BENEFIT [126003]", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA POS [130007]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA GENERIC [130017]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE POS [130008]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA PPO [130005]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA HMO [130003]", "standard_charge_percentage": 49.9, "standard_charge_algorithm": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs & Biologicals; 49.9% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BC IPA HMO LAKE COUNTY PHYS [140136]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "BCBS INDEMNITY/OTHER [140108]", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $10.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $10.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "FIRST HEALTH TPA GENERIC [603402]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-COVENTRY NATIONAL NETWORK [603401]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "X-FIRST HEALTH BAS - NU VISITING SCHOLAR [603406]", "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $17,327 CASE RATE" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA CHOICE CARE PPO [130001]", "standard_charge_percentage": 56.5, "standard_charge_algorithm": "OP Procedure; 56.5% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Procedure; 56.5% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "HEALTHLINK SEIU GROUP [125008]", "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "HFN PLATINUM/CHC [126021]", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "All Procedures; 65% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Procedures; 65% Billed" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "HUMANA IPA HMO LAKE COUNTY PHYS [130016]", "standard_charge_percentage": 45.0, "standard_charge_algorithm": "All Other Procedures; 45% Billed", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedures; 45% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "HEALTH ALLIANCE PPO [181003]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE HMO/POS [181004]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 [181]", "plan_name": "HEALTH ALLIANCE STATE OF ILLINOIS HMO [181005]", "standard_charge_percentage": 34.3, "standard_charge_algorithm": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "ALTERNATE BLUE CROSS MEDICARE ADV [230401]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "ALTERNATE HUMANA IPA MEDICARE ADV [240901]", "standard_charge_algorithm": "External reimbursement not supported; No contract line matched", "median_amount": 2.92, "10th_percentile": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "other", "additional_payer_notes": "External reimbursement not supported; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA WEB TPA ASA [171060]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA CORESOURCE (TRUSTMARK) ASA [171053]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSCOPE ASA [171086]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA NIPPON ASA [171014]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA AMERIBEN ASA [171048]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA TRUSTMARK ASA [171056]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA HEALTHSMART ASA [171112]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED BENEFIT ASA [171006]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA GENERIC TPA ASA [171097]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "AETNA ALLIED - AH/ASA [171110]", "standard_charge_percentage": 48.73, "standard_charge_algorithm": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 1.28, "90th_percentile": 8.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 48.73% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is 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": "AMPLATZ SUPER STIFF GUIDEWIRE STR TIP 0.035INX260", "code_information": [ { "code": "SUP-9042188", "type": "CDM" }, { "code": "C1769", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 102.41, "maximum": 616.95, "setting": "outpatient", "gross_charge": 616.95, "discounted_cash": 431.86, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 616.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $616.95 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $616.95 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 277.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 396.27, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 129.56, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH CIGNA BROAD", "standard_charge_dollar": 299.84, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 292.43, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH FIRST HEALTH", "standard_charge_dollar": 505.9, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $18,557 CASE RATE" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 265.29, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 280.71, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 45.5% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PPO", "standard_charge_dollar": 555.26, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 394.23, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTH ALLIANCE [181]", "plan_name": "NLFH HEALTH ALLIANCE", "standard_charge_dollar": 210.38, "standard_charge_percentage": 34.1, "standard_charge_algorithm": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 34.1% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 308.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 325.13, "standard_charge_percentage": 52.7, "standard_charge_algorithm": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 52.7% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH PHCS", "standard_charge_dollar": 493.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 493.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 130.73, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 130.73, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 168.43, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 168.43, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 102.41, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 102.41, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 144.37, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 144.37, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 144.37, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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 MEDICARE IMMUNIZATION BILLING [2011]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price" }, { "payer_name": "HOSPICE [6010]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE MEDICARE LOC BILLING [2417]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 12.8% = $78.97 due to $0.00 Claim Price" }, { "payer_name": "MEDICAID REPLACEMENT [1601]", "plan_name": "NLFH ILLINOIS MEDICAID", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 6.3% = $38.87 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": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APGs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APG FOR NLFH; Note: Multiple pricing methods applied. Percent of APG: $0.00 @ 100% = $0.00. Percent of Claim Billed: $616.95 @ 6.3% = $38.87 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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HUMANA MEDICARE ADVT & MMAI", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH UHC MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH BLUE CROSS MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH AETNA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH ZING HEALTH MA & MMAI (MEDICARE)", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MEDICARE ADVANTAGE [1301]", "plan_name": "NLFH HEALTH ALLIANCE MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 296.09, "10th_percentile": 107.23, "90th_percentile": 616.95, "count": "26", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMPLATZER 4 5X10.5MM PLUG VASC OCCL", "code_information": [ { "code": "SUP-143419", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1382.81, "maximum": 8330.17, "setting": "outpatient", "gross_charge": 8330.17, "discounted_cash": 5831.12, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1949.26, "standard_charge_percentage": 23.4, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 23.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1765.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1765.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2274.14, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH BCBS PPO", "standard_charge_dollar": 2274.14, "standard_charge_percentage": 27.3, "standard_charge_algorithm": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 27.3% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount." }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1382.81, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1382.81, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6664.14, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6664.14, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3748.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 5350.47, "standard_charge_percentage": 64.23, "standard_charge_algorithm": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 64.23% Billed, and; Pricing Extension - NM HB 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": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1749.34, "standard_charge_percentage": 21.0, "standard_charge_algorithm": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 21% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH UHC CORE", "standard_charge_dollar": 3948.5, "standard_charge_percentage": 47.4, "standard_charge_algorithm": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Table 5 Services; 47.4% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 5322.98, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3581.97, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Outpatient; 43% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 4165.09, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 4048.46, "standard_charge_percentage": 48.6, "standard_charge_algorithm": "All Other Outpatient; 48.6% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 3981.85, "10th_percentile": 1066.26, "90th_percentile": 8330.17, "count": "1 through 10", "methodo