{ "hospital_name": "Northwestern Lake Forest Hospital", "last_updated_on": "2026-04-01", "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": "0005660 | 22002", "state": "IL" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "John Orsini" }, "type_2_npi": [ "1124025176" ], "standard_charge_information": [ { "description": "1.5MM TI CORTEX SCREW SELF-TAPPING 6MM", "code_information": [ { "code": "SUP-49999", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 121.64, "maximum": 732.76, "setting": "outpatient", "gross_charge": 732.76, "discounted_cash": 512.93, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 386.16, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 356.12, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 121.64, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 171.47, "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": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "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": 171.47, "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": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "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": 171.47, "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": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 586.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 586.21, "10th_percentile": 586.21, "90th_percentile": 586.21, "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": 586.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 586.21, "10th_percentile": 586.21, "90th_percentile": 586.21, "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": 200.04, "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": 200.04, "10th_percentile": 200.04, "90th_percentile": 200.04, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 200.04, "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": 200.04, "10th_percentile": 200.04, "90th_percentile": 200.04, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 155.27, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 155.27, "10th_percentile": 155.27, "90th_percentile": 155.27, "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": 155.27, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 155.27, "10th_percentile": 155.27, "90th_percentile": 155.27, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 732.76, "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 $732.76 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "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 $732.76 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 732.76, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 564.23, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 564.23, "10th_percentile": 564.23, "90th_percentile": 564.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 468.23, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 468.23, "10th_percentile": 468.23, "90th_percentile": 468.23, "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": 315.09, "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": 315.09, "10th_percentile": 315.09, "90th_percentile": 315.09, "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": 366.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 366.38, "10th_percentile": 366.38, "90th_percentile": 366.38, "count": "0", "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": 470.65, "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": 470.65, "10th_percentile": 470.65, "90th_percentile": 470.65, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 333.41, "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": 333.41, "10th_percentile": 333.41, "90th_percentile": 333.41, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 659.48, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 659.48, "10th_percentile": 659.48, "90th_percentile": 659.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 347.33, "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": 347.33, "10th_percentile": 347.33, "90th_percentile": 347.33, "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": 153.88, "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": 153.88, "10th_percentile": 153.88, "90th_percentile": 153.88, "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": "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: $732.76 @ 12.8% = $93.79 due to $0.00 Claim Price", "median_amount": 93.79, "10th_percentile": 93.79, "90th_percentile": 93.79, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $732.76 @ 12.8% = $93.79 due to $0.00 Claim Price" }, { "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": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "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": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "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": 732.76, "10th_percentile": 732.76, "90th_percentile": 732.76, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "10 DEG ILIAC SCREW 7.5X100 TI", "code_information": [ { "code": "SUP-305539", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "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 $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "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 $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "105MM PRE BENT SPHERX ROD", "code_information": [ { "code": "SUP-307196", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 509.46, "maximum": 3069.01, "setting": "outpatient", "gross_charge": 3069.01, "discounted_cash": 2148.31, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 509.46, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1617.37, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": 1534.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1534.51, "10th_percentile": 1534.51, "90th_percentile": 1534.51, "count": "0", "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": 1454.71, "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": 1454.71, "10th_percentile": 1454.71, "90th_percentile": 1454.71, "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": 2363.14, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2363.14, "10th_percentile": 2363.14, "90th_percentile": 2363.14, "count": "0", "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": 1491.54, "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": 1491.54, "10th_percentile": 1491.54, "90th_percentile": 1491.54, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1971.23, "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": 1971.23, "10th_percentile": 1971.23, "90th_percentile": 1971.23, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1396.4, "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": 1396.4, "10th_percentile": 1396.4, "90th_percentile": 1396.4, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1961.1, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1961.1, "10th_percentile": 1961.1, "90th_percentile": 1961.1, "count": "0", "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": 644.49, "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": 644.49, "10th_percentile": 644.49, "90th_percentile": 644.49, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1381.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1381.05, "10th_percentile": 1381.05, "90th_percentile": 1381.05, "count": "0", "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": 1319.67, "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": 1319.67, "10th_percentile": 1319.67, "90th_percentile": 1319.67, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3069.01, "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 $3,069.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3069.01, "10th_percentile": 3069.01, "90th_percentile": 3069.01, "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 $3,069.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3069.01, "10th_percentile": 3069.01, "90th_percentile": 3069.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3069.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3069.01, "10th_percentile": 3069.01, "90th_percentile": 3069.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2455.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2455.21, "10th_percentile": 2455.21, "90th_percentile": 2455.21, "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": 2455.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2455.21, "10th_percentile": 2455.21, "90th_percentile": 2455.21, "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": 837.84, "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": 837.84, "10th_percentile": 837.84, "90th_percentile": 837.84, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 837.84, "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": 837.84, "10th_percentile": 837.84, "90th_percentile": 837.84, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 650.32, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 650.32, "10th_percentile": 650.32, "90th_percentile": 650.32, "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": 650.32, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 650.32, "10th_percentile": 650.32, "90th_percentile": 650.32, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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 SELECT", "standard_charge_dollar": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3069.01, "10th_percentile": 3069.01, "90th_percentile": 3069.01, "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": 3069.01, "10th_percentile": 3069.01, "90th_percentile": 3069.01, "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": 3069.01, "10th_percentile": 3069.01, "90th_percentile": 3069.01, "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": 3069.01, "10th_percentile": 3069.01, "90th_percentile": 3069.01, "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_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: $3,069.01 @ 12.8% = $392.83 due to $0.00 Claim Price", "median_amount": 392.83, "10th_percentile": 392.83, "90th_percentile": 392.83, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,069.01 @ 12.8% = $392.83 due to $0.00 Claim Price" } ] } ] }, { "description": "16MM X10 CROSSLINK FIXED", "code_information": [ { "code": "SUP-108409", "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": "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": "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": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": "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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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 HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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 $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% 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": 1432.79, "10th_percentile": 1432.79, "90th_percentile": 1432.79, "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": "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": 1579.4, "10th_percentile": 1579.4, "90th_percentile": 1579.4, "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": "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": 1516.09, "10th_percentile": 1516.09, "90th_percentile": 1516.09, "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": "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": 2140.19, "10th_percentile": 2140.19, "90th_percentile": 2140.19, "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": "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": 2998.86, "10th_percentile": 2998.86, "90th_percentile": 2998.86, "count": "0", "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": 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": 699.73, "10th_percentile": 699.73, "90th_percentile": 699.73, "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": "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": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2129.19, "10th_percentile": 2129.19, "90th_percentile": 2129.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 2565.69, "10th_percentile": 2565.69, "90th_percentile": 2565.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 426.5, "10th_percentile": 426.5, "90th_percentile": 426.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "2.4MM VA-LCP VOLAR RIM DSTL RAD PLT 6H HD 5H SHAFT RT", "code_information": [ { "code": "SUP-377023", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1270.47, "maximum": 7653.41, "setting": "outpatient", "gross_charge": 7653.41, "discounted_cash": 5357.39, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1270.47, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 3719.56, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4033.35, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1790.9, "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": 1790.9, "10th_percentile": 1790.9, "90th_percentile": 1790.9, "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": 1790.9, "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": 1790.9, "10th_percentile": 1790.9, "90th_percentile": 1790.9, "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": 1790.9, "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": 1790.9, "10th_percentile": 1790.9, "90th_percentile": 1790.9, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6122.73, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6122.73, "10th_percentile": 6122.73, "90th_percentile": 6122.73, "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": 6122.73, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6122.73, "10th_percentile": 6122.73, "90th_percentile": 6122.73, "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": 2089.38, "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": 2089.38, "10th_percentile": 2089.38, "90th_percentile": 2089.38, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2089.38, "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": 2089.38, "10th_percentile": 2089.38, "90th_percentile": 2089.38, "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 HMO", "standard_charge_dollar": 1621.76, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1621.76, "10th_percentile": 1621.76, "90th_percentile": 1621.76, "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 HMO", "standard_charge_dollar": 1621.76, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1621.76, "10th_percentile": 1621.76, "90th_percentile": 1621.76, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7653.41, "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 $7,653.41 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "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 $7,653.41 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7653.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3290.97, "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": 3290.97, "10th_percentile": 3290.97, "90th_percentile": 3290.97, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3627.72, "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": 3627.72, "10th_percentile": 3627.72, "90th_percentile": 3627.72, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3482.3, "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": 3482.3, "10th_percentile": 3482.3, "90th_percentile": 3482.3, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4915.79, "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": 4915.79, "10th_percentile": 4915.79, "90th_percentile": 4915.79, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6888.07, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6888.07, "10th_percentile": 6888.07, "90th_percentile": 6888.07, "count": "0", "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": 1607.22, "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": 1607.22, "10th_percentile": 1607.22, "90th_percentile": 1607.22, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3826.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3826.71, "10th_percentile": 3826.71, "90th_percentile": 3826.71, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 4890.53, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4890.53, "10th_percentile": 4890.53, "90th_percentile": 4890.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5893.13, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5893.13, "10th_percentile": 5893.13, "90th_percentile": 5893.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $7,653.41 @ 12.8% = $979.64 due to $0.00 Claim Price", "median_amount": 979.64, "10th_percentile": 979.64, "90th_percentile": 979.64, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,653.41 @ 12.8% = $979.64 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "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": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "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": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "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": 7653.41, "10th_percentile": 7653.41, "90th_percentile": 7653.41, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "2.7MM CORT SCR SELF-TAP SMALL HEX 12MM", "code_information": [ { "code": "SUP-353431", "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": "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "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": 93.52, "10th_percentile": 93.52, "90th_percentile": 93.52, "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": "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": 126.72, "10th_percentile": 126.72, "90th_percentile": 126.72, "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": "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "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": 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": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "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 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": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "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": "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": 157.83, "10th_percentile": 157.83, "90th_percentile": 157.83, "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": 157.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 157.83, "10th_percentile": 157.83, "90th_percentile": 157.83, "count": "0", "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": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "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": 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": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "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": "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": 41.81, "10th_percentile": 41.81, "90th_percentile": 41.81, "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": 41.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 41.81, "10th_percentile": 41.81, "90th_percentile": 41.81, "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 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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "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 $197.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "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": 151.91, "10th_percentile": 151.91, "90th_percentile": 151.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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": 126.07, "10th_percentile": 126.07, "90th_percentile": 126.07, "count": "0", "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": 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": 41.43, "10th_percentile": 41.43, "90th_percentile": 41.43, "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": "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": 84.83, "10th_percentile": 84.83, "90th_percentile": 84.83, "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": 98.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 98.65, "10th_percentile": 98.65, "90th_percentile": 98.65, "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 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": 89.77, "10th_percentile": 89.77, "90th_percentile": 89.77, "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": "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": 177.56, "10th_percentile": 177.56, "90th_percentile": 177.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "2.7MM CORT SCR SELF-TAP SMALL HEX 42MM", "code_information": [ { "code": "SUP-353326", "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": "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "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": 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": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "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": 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": 46.17, "10th_percentile": 46.17, "90th_percentile": 46.17, "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": "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": 157.83, "10th_percentile": 157.83, "90th_percentile": 157.83, "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": 157.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 157.83, "10th_percentile": 157.83, "90th_percentile": 157.83, "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": 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": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "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": "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": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "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 HMO", "standard_charge_dollar": 41.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 41.81, "10th_percentile": 41.81, "90th_percentile": 41.81, "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 HMO", "standard_charge_dollar": 41.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 41.81, "10th_percentile": 41.81, "90th_percentile": 41.81, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "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 $197.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 197.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% 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": 84.83, "10th_percentile": 84.83, "90th_percentile": 84.83, "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": "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": 93.52, "10th_percentile": 93.52, "90th_percentile": 93.52, "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": "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": 89.77, "10th_percentile": 89.77, "90th_percentile": 89.77, "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": "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": 126.72, "10th_percentile": 126.72, "90th_percentile": 126.72, "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": "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": 177.56, "10th_percentile": 177.56, "90th_percentile": 177.56, "count": "0", "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": 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": 41.43, "10th_percentile": 41.43, "90th_percentile": 41.43, "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": "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": 98.65, "10th_percentile": 98.65, "90th_percentile": 98.65, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 126.07, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 126.07, "10th_percentile": 126.07, "90th_percentile": 126.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 151.91, "10th_percentile": 151.91, "90th_percentile": 151.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $197.29 @ 12.8% = $25.25 due to $0.00 Claim Price", "median_amount": 25.25, "10th_percentile": 25.25, "90th_percentile": 25.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "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": 197.29, "10th_percentile": 197.29, "90th_percentile": 197.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "20 DEG ILIAC SCREW 8.5X50 TI", "code_information": [ { "code": "SUP-305579", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "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 $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "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 $0.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" } ] } ] }, { "description": "21GA X 15CM NEEDLE PERC ENTRY ECHOTP W/O BASEPLT", "code_information": [ { "code": "SUP-150868", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 4.21, "maximum": 25.34, "setting": "outpatient", "gross_charge": 25.34, "discounted_cash": 17.74, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 6.92, "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": 6.92, "10th_percentile": 6.92, "90th_percentile": 6.92, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 6.92, "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": 6.92, "10th_percentile": 6.92, "90th_percentile": 6.92, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 5.37, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5.37, "10th_percentile": 5.37, "90th_percentile": 5.37, "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 HMO", "standard_charge_dollar": 5.37, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5.37, "10th_percentile": 5.37, "90th_percentile": 5.37, "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": 20.27, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 20.27, "10th_percentile": 20.27, "90th_percentile": 20.27, "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": 20.27, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 20.27, "10th_percentile": 20.27, "90th_percentile": 20.27, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 25.34, "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 $25.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "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 $25.34 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": 5.9, "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": 5.9, "10th_percentile": 5.9, "90th_percentile": 5.9, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 5.58, "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": 5.58, "10th_percentile": 5.58, "90th_percentile": 5.58, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 11.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 11.4, "10th_percentile": 11.4, "90th_percentile": 11.4, "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": 5.31, "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": 5.31, "10th_percentile": 5.31, "90th_percentile": 5.31, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 22.81, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 22.81, "10th_percentile": 22.81, "90th_percentile": 22.81, "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": 12.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 12.67, "10th_percentile": 12.67, "90th_percentile": 12.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 20.78, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 20.78, "10th_percentile": 20.78, "90th_percentile": 20.78, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 12.32, "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": 12.32, "10th_percentile": 12.32, "90th_percentile": 12.32, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 16.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 16.19, "10th_percentile": 16.19, "90th_percentile": 16.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 4.21, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 4.21, "10th_percentile": 4.21, "90th_percentile": 4.21, "count": "0", "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": 16.28, "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": 16.28, "10th_percentile": 16.28, "90th_percentile": 16.28, "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": 13.35, "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": 13.35, "10th_percentile": 13.35, "90th_percentile": 13.35, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 12.01, "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": 12.01, "10th_percentile": 12.01, "90th_percentile": 12.01, "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": 5.32, "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": 5.32, "10th_percentile": 5.32, "90th_percentile": 5.32, "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": 10.9, "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": 10.9, "10th_percentile": 10.9, "90th_percentile": 10.9, "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 ASA", "standard_charge_dollar": 11.53, "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": 11.53, "10th_percentile": 11.53, "90th_percentile": 11.53, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "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": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "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": 25.34, "10th_percentile": 25.34, "90th_percentile": 25.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "25G RETROBULBAR NEEDLE", "code_information": [ { "code": "SUP-348208", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 2.91, "maximum": 17.54, "setting": "outpatient", "gross_charge": 17.54, "discounted_cash": 12.28, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 14.03, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.03, "10th_percentile": 14.03, "90th_percentile": 14.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 11.27, "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": 11.27, "10th_percentile": 11.27, "90th_percentile": 11.27, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 8.77, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 8.77, "10th_percentile": 8.77, "90th_percentile": 8.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 8.31, "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": 8.31, "10th_percentile": 8.31, "90th_percentile": 8.31, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 9.24, "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": 9.24, "10th_percentile": 9.24, "90th_percentile": 9.24, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 17.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 11.21, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 11.21, "10th_percentile": 11.21, "90th_percentile": 11.21, "count": "0", "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": 15.79, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 15.79, "10th_percentile": 15.79, "90th_percentile": 15.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "count": "0", "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": 14.03, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.03, "10th_percentile": 14.03, "90th_percentile": 14.03, "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 HMO", "standard_charge_dollar": 3.72, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.72, "10th_percentile": 3.72, "90th_percentile": 3.72, "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 HMO", "standard_charge_dollar": 3.72, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.72, "10th_percentile": 3.72, "90th_percentile": 3.72, "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": 4.79, "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": 4.79, "10th_percentile": 4.79, "90th_percentile": 4.79, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 4.79, "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": 4.79, "10th_percentile": 4.79, "90th_percentile": 4.79, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 17.54, "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 $17.54 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "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 $17.54 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": 3.86, "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": 3.86, "10th_percentile": 3.86, "90th_percentile": 3.86, "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": 3.68, "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": 3.68, "10th_percentile": 3.68, "90th_percentile": 3.68, "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": 4.08, "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": 4.08, "10th_percentile": 4.08, "90th_percentile": 4.08, "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": 7.89, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 7.89, "10th_percentile": 7.89, "90th_percentile": 7.89, "count": "0", "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": 7.54, "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": 7.54, "10th_percentile": 7.54, "90th_percentile": 7.54, "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": 2.91, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2.91, "10th_percentile": 2.91, "90th_percentile": 2.91, "count": "0", "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": 14.38, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 14.38, "10th_percentile": 14.38, "90th_percentile": 14.38, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 8.52, "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": 8.52, "10th_percentile": 8.52, "90th_percentile": 8.52, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 3.68, "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": 3.68, "10th_percentile": 3.68, "90th_percentile": 3.68, "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 ASA", "standard_charge_dollar": 7.98, "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": 7.98, "10th_percentile": 7.98, "90th_percentile": 7.98, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "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": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "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": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "25MM X10 CROSSLINK FIXED", "code_information": [ { "code": "SUP-106299", "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": "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": "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": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "count": "0", "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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": 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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": "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": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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 $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "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": 2565.69, "10th_percentile": 2565.69, "90th_percentile": 2565.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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": 2129.19, "10th_percentile": 2129.19, "90th_percentile": 2129.19, "count": "0", "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": 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": 699.73, "10th_percentile": 699.73, "90th_percentile": 699.73, "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": "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": 2140.19, "10th_percentile": 2140.19, "90th_percentile": 2140.19, "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": 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": 1579.4, "10th_percentile": 1579.4, "90th_percentile": 1579.4, "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": "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": 1432.79, "10th_percentile": 1432.79, "90th_percentile": 1432.79, "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": "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": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "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 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": 1516.09, "10th_percentile": 1516.09, "90th_percentile": 1516.09, "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": "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": 2998.86, "10th_percentile": 2998.86, "90th_percentile": 2998.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 426.5, "10th_percentile": 426.5, "90th_percentile": 426.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.2MM TITANIUM ROD 240MM", "code_information": [ { "code": "SUP-58639", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 172.85, "maximum": 1041.27, "setting": "outpatient", "gross_charge": 1041.27, "discounted_cash": 728.89, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 172.85, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 506.06, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 548.75, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 243.66, "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": 243.66, "10th_percentile": 243.66, "90th_percentile": 243.66, "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": 243.66, "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": 243.66, "10th_percentile": 243.66, "90th_percentile": 243.66, "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": 243.66, "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": 243.66, "10th_percentile": 243.66, "90th_percentile": 243.66, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "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": 833.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "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": 284.27, "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": 284.27, "10th_percentile": 284.27, "90th_percentile": 284.27, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 284.27, "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": 284.27, "10th_percentile": 284.27, "90th_percentile": 284.27, "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 HMO", "standard_charge_dollar": 220.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 220.65, "10th_percentile": 220.65, "90th_percentile": 220.65, "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 HMO", "standard_charge_dollar": 220.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 220.65, "10th_percentile": 220.65, "90th_percentile": 220.65, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1041.27, "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 $1,041.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "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 $1,041.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1041.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 447.75, "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": 447.75, "10th_percentile": 447.75, "90th_percentile": 447.75, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 493.56, "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": 493.56, "10th_percentile": 493.56, "90th_percentile": 493.56, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 473.78, "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": 473.78, "10th_percentile": 473.78, "90th_percentile": 473.78, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 668.81, "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": 668.81, "10th_percentile": 668.81, "90th_percentile": 668.81, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 937.14, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 937.14, "10th_percentile": 937.14, "90th_percentile": 937.14, "count": "0", "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": 218.67, "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": 218.67, "10th_percentile": 218.67, "90th_percentile": 218.67, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 520.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 520.64, "10th_percentile": 520.64, "90th_percentile": 520.64, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 665.37, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 665.37, "10th_percentile": 665.37, "90th_percentile": 665.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 801.78, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 801.78, "10th_percentile": 801.78, "90th_percentile": 801.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $1,041.27 @ 12.8% = $133.28 due to $0.00 Claim Price", "median_amount": 133.28, "10th_percentile": 133.28, "90th_percentile": 133.28, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,041.27 @ 12.8% = $133.28 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "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": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "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": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "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": 1041.27, "10th_percentile": 1041.27, "90th_percentile": 1041.27, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.5MM CANN SCR FULL THD 34MM", "code_information": [ { "code": "SUP-353224", "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": "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "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": 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": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "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 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": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "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": "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": 1234.62, "10th_percentile": 1234.62, "90th_percentile": 1234.62, "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": 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": 421.31, "10th_percentile": 421.31, "90th_percentile": 421.31, "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": "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": 327.02, "10th_percentile": 327.02, "90th_percentile": 327.02, "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": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 327.02, "10th_percentile": 327.02, "90th_percentile": 327.02, "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 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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% 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": 663.61, "10th_percentile": 663.61, "90th_percentile": 663.61, "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 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": 702.19, "10th_percentile": 702.19, "90th_percentile": 702.19, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1234.62, "10th_percentile": 1234.62, "90th_percentile": 1234.62, "count": "0", "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": 421.31, "10th_percentile": 421.31, "90th_percentile": 421.31, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "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 $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% 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": 731.51, "10th_percentile": 731.51, "90th_percentile": 731.51, "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": "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": 991.24, "10th_percentile": 991.24, "90th_percentile": 991.24, "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": "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": 1388.94, "10th_percentile": 1388.94, "90th_percentile": 1388.94, "count": "0", "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": 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": 324.09, "10th_percentile": 324.09, "90th_percentile": 324.09, "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": "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": 771.64, "10th_percentile": 771.64, "90th_percentile": 771.64, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 986.15, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 986.15, "10th_percentile": 986.15, "90th_percentile": 986.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% 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": 1188.32, "10th_percentile": 1188.32, "90th_percentile": 1188.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 197.54, "10th_percentile": 197.54, "90th_percentile": 197.54, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3.5MM CANN SCR PARTIAL THD 18MM", "code_information": [ { "code": "SUP-353206", "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": "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "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": 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": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "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 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": 361.13, "10th_percentile": 361.13, "90th_percentile": 361.13, "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": "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": 1234.62, "10th_percentile": 1234.62, "90th_percentile": 1234.62, "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": 1234.62, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1234.62, "10th_percentile": 1234.62, "90th_percentile": 1234.62, "count": "0", "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": 421.31, "10th_percentile": 421.31, "90th_percentile": 421.31, "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": 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": 421.31, "10th_percentile": 421.31, "90th_percentile": 421.31, "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": "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": 327.02, "10th_percentile": 327.02, "90th_percentile": 327.02, "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": 327.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 327.02, "10th_percentile": 327.02, "90th_percentile": 327.02, "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 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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "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 $1,543.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1543.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% 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": 1188.32, "10th_percentile": 1188.32, "90th_percentile": 1188.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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": 986.15, "10th_percentile": 986.15, "90th_percentile": 986.15, "count": "0", "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": 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": 324.09, "10th_percentile": 324.09, "90th_percentile": 324.09, "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": "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": 991.24, "10th_percentile": 991.24, "90th_percentile": 991.24, "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": 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": 731.51, "10th_percentile": 731.51, "90th_percentile": 731.51, "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": "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": 771.64, "10th_percentile": 771.64, "90th_percentile": 771.64, "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": 1388.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1388.94, "10th_percentile": 1388.94, "90th_percentile": 1388.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $1,543.27 @ 12.8% = $197.54 due to $0.00 Claim Price", "median_amount": 197.54, "10th_percentile": 197.54, "90th_percentile": 197.54, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "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": 256.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 663.61, "10th_percentile": 663.61, "90th_percentile": 663.61, "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 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": 702.19, "10th_percentile": 702.19, "90th_percentile": 702.19, "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": "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": 1543.27, "10th_percentile": 1543.27, "90th_percentile": 1543.27, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "3D THREAD SCRW 5.5MMX45 TI", "code_information": [ { "code": "SUP-70555", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 577.87, "maximum": 3481.13, "setting": "outpatient", "gross_charge": 3481.13, "discounted_cash": 2436.79, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1834.56, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1691.83, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 577.87, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 814.58, "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": 814.58, "10th_percentile": 814.58, "90th_percentile": 814.58, "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": 814.58, "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": 814.58, "10th_percentile": 814.58, "90th_percentile": 814.58, "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 SELECT", "standard_charge_dollar": 814.58, "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": 814.58, "10th_percentile": 814.58, "90th_percentile": 814.58, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2784.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2784.9, "10th_percentile": 2784.9, "90th_percentile": 2784.9, "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": 2784.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2784.9, "10th_percentile": 2784.9, "90th_percentile": 2784.9, "count": "0", "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": 950.35, "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": 950.35, "10th_percentile": 950.35, "90th_percentile": 950.35, "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": 950.35, "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": 950.35, "10th_percentile": 950.35, "90th_percentile": 950.35, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 737.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 737.65, "10th_percentile": 737.65, "90th_percentile": 737.65, "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": 737.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 737.65, "10th_percentile": 737.65, "90th_percentile": 737.65, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3481.13, "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 $3,481.13 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "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 $3,481.13 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3481.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2680.47, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2680.47, "10th_percentile": 2680.47, "90th_percentile": 2680.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2224.44, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2224.44, "10th_percentile": 2224.44, "90th_percentile": 2224.44, "count": "0", "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": 731.04, "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": 731.04, "10th_percentile": 731.04, "90th_percentile": 731.04, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2235.93, "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": 2235.93, "10th_percentile": 2235.93, "90th_percentile": 2235.93, "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": 1650.06, "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": 1650.06, "10th_percentile": 1650.06, "90th_percentile": 1650.06, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1496.89, "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": 1496.89, "10th_percentile": 1496.89, "90th_percentile": 1496.89, "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": 1740.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1740.57, "10th_percentile": 1740.57, "90th_percentile": 1740.57, "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 ASA", "standard_charge_dollar": 1583.91, "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": 1583.91, "10th_percentile": 1583.91, "90th_percentile": 1583.91, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3133.02, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3133.02, "10th_percentile": 3133.02, "90th_percentile": 3133.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $3,481.13 @ 12.8% = $445.58 due to $0.00 Claim Price", "median_amount": 445.58, "10th_percentile": 445.58, "90th_percentile": 445.58, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,481.13 @ 12.8% = $445.58 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "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": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "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": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "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": 3481.13, "10th_percentile": 3481.13, "90th_percentile": 3481.13, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.0 X 15 SELF-DRILL FIX SCREW", "code_information": [ { "code": "SUP-106687", "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": "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 194.93, "10th_percentile": 194.93, "90th_percentile": 194.93, "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": 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": 194.93, "10th_percentile": 194.93, "90th_percentile": 194.93, "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": 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": 194.93, "10th_percentile": 194.93, "90th_percentile": 194.93, "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": "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": 666.42, "10th_percentile": 666.42, "90th_percentile": 666.42, "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": 666.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 666.42, "10th_percentile": 666.42, "90th_percentile": 666.42, "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": 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": 227.41, "10th_percentile": 227.41, "90th_percentile": 227.41, "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": "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": 227.41, "10th_percentile": 227.41, "90th_percentile": 227.41, "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 HMO", "standard_charge_dollar": 176.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 176.52, "10th_percentile": 176.52, "90th_percentile": 176.52, "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 HMO", "standard_charge_dollar": 176.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 176.52, "10th_percentile": 176.52, "90th_percentile": 176.52, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "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 $833.02 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 833.02, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% 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": 358.2, "10th_percentile": 358.2, "90th_percentile": 358.2, "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": "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": 394.85, "10th_percentile": 394.85, "90th_percentile": 394.85, "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": "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": 379.02, "10th_percentile": 379.02, "90th_percentile": 379.02, "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": "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": 535.05, "10th_percentile": 535.05, "90th_percentile": 535.05, "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": "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": 749.72, "10th_percentile": 749.72, "90th_percentile": 749.72, "count": "0", "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": 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": 174.93, "10th_percentile": 174.93, "90th_percentile": 174.93, "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": "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": 416.51, "10th_percentile": 416.51, "90th_percentile": 416.51, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 532.3, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 532.3, "10th_percentile": 532.3, "90th_percentile": 532.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 641.43, "10th_percentile": 641.43, "90th_percentile": 641.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $833.02 @ 12.8% = $106.63 due to $0.00 Claim Price", "median_amount": 106.63, "10th_percentile": 106.63, "90th_percentile": 106.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "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": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "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": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "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": 833.02, "10th_percentile": 833.02, "90th_percentile": 833.02, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.0MM CANC SCR SMALL HEX 32MM FULLY THD", "code_information": [ { "code": "SUP-353366", "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": "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 45.65, "10th_percentile": 45.65, "90th_percentile": 45.65, "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": 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": 45.65, "10th_percentile": 45.65, "90th_percentile": 45.65, "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": 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": 45.65, "10th_percentile": 45.65, "90th_percentile": 45.65, "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": "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": 156.08, "10th_percentile": 156.08, "90th_percentile": 156.08, "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": 156.08, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 156.08, "10th_percentile": 156.08, "90th_percentile": 156.08, "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": 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": 53.26, "10th_percentile": 53.26, "90th_percentile": 53.26, "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": "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": 53.26, "10th_percentile": 53.26, "90th_percentile": 53.26, "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 HMO", "standard_charge_dollar": 41.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 41.34, "10th_percentile": 41.34, "90th_percentile": 41.34, "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 HMO", "standard_charge_dollar": 41.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 41.34, "10th_percentile": 41.34, "90th_percentile": 41.34, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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 $195.10 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 195.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% 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": 83.89, "10th_percentile": 83.89, "90th_percentile": 83.89, "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": "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": 92.48, "10th_percentile": 92.48, "90th_percentile": 92.48, "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": "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": 88.77, "10th_percentile": 88.77, "90th_percentile": 88.77, "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": "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": 125.31, "10th_percentile": 125.31, "90th_percentile": 125.31, "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": "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": 175.59, "10th_percentile": 175.59, "90th_percentile": 175.59, "count": "0", "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": 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": 40.97, "10th_percentile": 40.97, "90th_percentile": 40.97, "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": "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": 97.55, "10th_percentile": 97.55, "90th_percentile": 97.55, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 124.67, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 124.67, "10th_percentile": 124.67, "90th_percentile": 124.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 150.23, "10th_percentile": 150.23, "90th_percentile": 150.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $195.10 @ 12.8% = $24.97 due to $0.00 Claim Price", "median_amount": 24.97, "10th_percentile": 24.97, "90th_percentile": 24.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.0MM CANN SCR 1/3 THD 10MM", "code_information": [ { "code": "SUP-353201", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 272.2, "maximum": 1639.73, "setting": "outpatient", "gross_charge": 1639.73, "discounted_cash": 1147.81, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 864.14, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 796.91, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 272.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 383.7, "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": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "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": 383.7, "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": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "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": 383.7, "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": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1311.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1311.78, "10th_percentile": 1311.78, "90th_percentile": 1311.78, "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": 1311.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1311.78, "10th_percentile": 1311.78, "90th_percentile": 1311.78, "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": 447.65, "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": 447.65, "10th_percentile": 447.65, "90th_percentile": 447.65, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 447.65, "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": 447.65, "10th_percentile": 447.65, "90th_percentile": 447.65, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 347.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 347.46, "10th_percentile": 347.46, "90th_percentile": 347.46, "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": 347.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 347.46, "10th_percentile": 347.46, "90th_percentile": 347.46, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1639.73, "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 $1,639.73 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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 $1,639.73 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1262.59, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1262.59, "10th_percentile": 1262.59, "90th_percentile": 1262.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1047.79, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1047.79, "10th_percentile": 1047.79, "90th_percentile": 1047.79, "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": 705.08, "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": 705.08, "10th_percentile": 705.08, "90th_percentile": 705.08, "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": 819.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 819.87, "10th_percentile": 819.87, "90th_percentile": 819.87, "count": "0", "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": 1053.2, "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": 1053.2, "10th_percentile": 1053.2, "90th_percentile": 1053.2, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 746.08, "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": 746.08, "10th_percentile": 746.08, "90th_percentile": 746.08, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1475.76, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1475.76, "10th_percentile": 1475.76, "90th_percentile": 1475.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 777.23, "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": 777.23, "10th_percentile": 777.23, "90th_percentile": 777.23, "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": 344.34, "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": 344.34, "10th_percentile": 344.34, "90th_percentile": 344.34, "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": "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: $1,639.73 @ 12.8% = $209.89 due to $0.00 Claim Price", "median_amount": 209.89, "10th_percentile": 209.89, "90th_percentile": 209.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,639.73 @ 12.8% = $209.89 due to $0.00 Claim Price" }, { "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.0MM CANN SCR 1/3 THD 26MM", "code_information": [ { "code": "SUP-353216", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 272.2, "maximum": 1639.73, "setting": "outpatient", "gross_charge": 1639.73, "discounted_cash": 1147.81, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 864.14, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 796.91, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 383.7, "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": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "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": 383.7, "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": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "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 SELECT", "standard_charge_dollar": 383.7, "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": 383.7, "10th_percentile": 383.7, "90th_percentile": 383.7, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1311.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1311.78, "10th_percentile": 1311.78, "90th_percentile": 1311.78, "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": 1311.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1311.78, "10th_percentile": 1311.78, "90th_percentile": 1311.78, "count": "0", "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": 447.65, "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": 447.65, "10th_percentile": 447.65, "90th_percentile": 447.65, "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": 447.65, "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": 447.65, "10th_percentile": 447.65, "90th_percentile": 447.65, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 347.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 347.46, "10th_percentile": 347.46, "90th_percentile": 347.46, "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": 347.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 347.46, "10th_percentile": 347.46, "90th_percentile": 347.46, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1639.73, "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 $1,639.73 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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 $1,639.73 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1262.59, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1262.59, "10th_percentile": 1262.59, "90th_percentile": 1262.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1047.79, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1047.79, "10th_percentile": 1047.79, "90th_percentile": 1047.79, "count": "0", "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": 344.34, "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": 344.34, "10th_percentile": 344.34, "90th_percentile": 344.34, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1053.2, "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": 1053.2, "10th_percentile": 1053.2, "90th_percentile": 1053.2, "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": 777.23, "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": 777.23, "10th_percentile": 777.23, "90th_percentile": 777.23, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 819.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 819.87, "10th_percentile": 819.87, "90th_percentile": 819.87, "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": 1475.76, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1475.76, "10th_percentile": 1475.76, "90th_percentile": 1475.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $1,639.73 @ 12.8% = $209.89 due to $0.00 Claim Price", "median_amount": 209.89, "10th_percentile": 209.89, "90th_percentile": 209.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,639.73 @ 12.8% = $209.89 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "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": 272.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 705.08, "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": 705.08, "10th_percentile": 705.08, "90th_percentile": 705.08, "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 ASA", "standard_charge_dollar": 746.08, "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": 746.08, "10th_percentile": 746.08, "90th_percentile": 746.08, "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": "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.0MM CANN SCRW-LONG THRD 52MM", "code_information": [ { "code": "SUP-377137", "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": "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 256.48, "10th_percentile": 256.48, "90th_percentile": 256.48, "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": 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": 256.48, "10th_percentile": 256.48, "90th_percentile": 256.48, "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 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": 256.48, "10th_percentile": 256.48, "90th_percentile": 256.48, "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": "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": 876.86, "10th_percentile": 876.86, "90th_percentile": 876.86, "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": 876.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 876.86, "10th_percentile": 876.86, "90th_percentile": 876.86, "count": "0", "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": 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": 299.23, "10th_percentile": 299.23, "90th_percentile": 299.23, "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": 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": 299.23, "10th_percentile": 299.23, "90th_percentile": 299.23, "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": "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": 232.26, "10th_percentile": 232.26, "90th_percentile": 232.26, "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": 232.26, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 232.26, "10th_percentile": 232.26, "90th_percentile": 232.26, "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 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": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "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 $1,096.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "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": 843.98, "10th_percentile": 843.98, "90th_percentile": 843.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "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": 700.4, "10th_percentile": 700.4, "90th_percentile": 700.4, "count": "0", "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": 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": 230.18, "10th_percentile": 230.18, "90th_percentile": 230.18, "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": "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": 704.01, "10th_percentile": 704.01, "90th_percentile": 704.01, "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": 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": 519.54, "10th_percentile": 519.54, "90th_percentile": 519.54, "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": "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": 471.31, "10th_percentile": 471.31, "90th_percentile": 471.31, "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": 548.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 548.04, "10th_percentile": 548.04, "90th_percentile": 548.04, "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 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": 498.72, "10th_percentile": 498.72, "90th_percentile": 498.72, "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": "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": 986.47, "10th_percentile": 986.47, "90th_percentile": 986.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $1,096.08 @ 12.8% = $140.30 due to $0.00 Claim Price", "median_amount": 140.3, "10th_percentile": 140.3, "90th_percentile": 140.3, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "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": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "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": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "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": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "4.5X15MM PK PAPYRUS COVERED STENT", "code_information": [ { "code": "SUP-350650", "type": "CDM" }, { "code": "C1874", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 3930.09, "maximum": 23675.22, "setting": "outpatient", "gross_charge": 23675.22, "discounted_cash": 16572.65, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 3930.09, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 541.38, "10th_percentile": 541.38, "90th_percentile": 541.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 12476.84, "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": 1112.15, "10th_percentile": 1112.15, "90th_percentile": 1112.15, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 23675.22, "10th_percentile": 23675.22, "90th_percentile": 23675.22, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 23675.22, "10th_percentile": 23675.22, "90th_percentile": 23675.22, "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": 23675.22, "10th_percentile": 23675.22, "90th_percentile": 23675.22, "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": 23675.22, "10th_percentile": 23675.22, "90th_percentile": 23675.22, "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_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: $23,675.22 @ 12.8% = $3,030.43 due to $0.00 Claim Price", "median_amount": 3030.43, "10th_percentile": 3030.43, "90th_percentile": 3030.43, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $23,675.22 @ 12.8% = $3,030.43 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5540.0, "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": 5540.0, "10th_percentile": 5540.0, "90th_percentile": 5540.0, "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": 5540.0, "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": 5540.0, "10th_percentile": 5540.0, "90th_percentile": 5540.0, "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 SELECT", "standard_charge_dollar": 5540.0, "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": 5540.0, "10th_percentile": 5540.0, "90th_percentile": 5540.0, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 5016.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5016.78, "10th_percentile": 5016.78, "90th_percentile": 5016.78, "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 HMO", "standard_charge_dollar": 5016.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5016.78, "10th_percentile": 5016.78, "90th_percentile": 5016.78, "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": 6463.34, "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": 6463.34, "10th_percentile": 6463.34, "90th_percentile": 6463.34, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 6463.34, "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": 6463.34, "10th_percentile": 6463.34, "90th_percentile": 6463.34, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 18940.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18940.18, "10th_percentile": 18940.18, "90th_percentile": 18940.18, "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": 18940.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18940.18, "10th_percentile": 18940.18, "90th_percentile": 18940.18, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 23675.22, "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 $23,675.22 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 23675.22, "10th_percentile": 23675.22, "90th_percentile": 23675.22, "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 $23,675.22 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 23675.22, "10th_percentile": 23675.22, "90th_percentile": 23675.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 23675.22, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 23675.22, "10th_percentile": 23675.22, "90th_percentile": 23675.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 18229.92, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 18229.92, "10th_percentile": 18229.92, "90th_percentile": 18229.92, "count": "0", "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": 21307.7, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 21307.7, "10th_percentile": 21307.7, "90th_percentile": 21307.7, "count": "0", "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": 11506.16, "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": 11506.16, "10th_percentile": 11506.16, "90th_percentile": 11506.16, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 15128.47, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 15128.47, "10th_percentile": 15128.47, "90th_percentile": 15128.47, "count": "0", "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": 11222.05, "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": 11222.05, "10th_percentile": 11222.05, "90th_percentile": 11222.05, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 15206.59, "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": 15206.59, "10th_percentile": 15206.59, "90th_percentile": 15206.59, "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": 4971.8, "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": 4971.8, "10th_percentile": 4971.8, "90th_percentile": 4971.8, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 10772.23, "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": 10772.23, "10th_percentile": 10772.23, "90th_percentile": 10772.23, "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": 11837.61, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "count": "0", "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": 10653.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 10653.85, "10th_percentile": 10653.85, "90th_percentile": 10653.85, "count": "0", "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": 10180.34, "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": 10180.34, "10th_percentile": 10180.34, "90th_percentile": 10180.34, "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." } ] } ] }, { "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": "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": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "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": 699.73, "10th_percentile": 699.73, "90th_percentile": 699.73, "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": 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": 1619.39, "10th_percentile": 1619.39, "90th_percentile": 1619.39, "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": "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": 2129.19, "10th_percentile": 2129.19, "90th_percentile": 2129.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 2565.69, "10th_percentile": 2565.69, "90th_percentile": 2565.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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": 1516.09, "10th_percentile": 1516.09, "90th_percentile": 1516.09, "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": "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": 2140.19, "10th_percentile": 2140.19, "90th_percentile": 2140.19, "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": "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": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "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": 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": 1579.4, "10th_percentile": 1579.4, "90th_percentile": 1579.4, "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": 2998.86, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2998.86, "10th_percentile": 2998.86, "90th_percentile": 2998.86, "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": "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": 1499.43, "10th_percentile": 1499.43, "90th_percentile": 1499.43, "count": "0", "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": 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": 1432.79, "10th_percentile": 1432.79, "90th_percentile": 1432.79, "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": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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 $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% 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": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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": 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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": 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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": "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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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_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": 426.5, "10th_percentile": 426.5, "90th_percentile": 426.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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" } ] } ] }, { "description": "5.5MM X 500MM OFFSET SRT COCR RELINE ROD", "code_information": [ { "code": "SUP-165763", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 363.9, "maximum": 2192.15, "setting": "outpatient", "gross_charge": 2192.15, "discounted_cash": 1534.5, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1155.26, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1065.38, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 363.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 512.96, "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": 512.96, "10th_percentile": 512.96, "90th_percentile": 512.96, "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": 512.96, "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": 512.96, "10th_percentile": 512.96, "90th_percentile": 512.96, "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 SELECT", "standard_charge_dollar": 512.96, "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": 512.96, "10th_percentile": 512.96, "90th_percentile": 512.96, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1753.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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": 1753.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "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": 598.46, "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": 598.46, "10th_percentile": 598.46, "90th_percentile": 598.46, "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": 598.46, "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": 598.46, "10th_percentile": 598.46, "90th_percentile": 598.46, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 464.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 464.52, "10th_percentile": 464.52, "90th_percentile": 464.52, "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": 464.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 464.52, "10th_percentile": 464.52, "90th_percentile": 464.52, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2192.15, "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 $2,192.15 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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 $2,192.15 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1687.96, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1687.96, "10th_percentile": 1687.96, "90th_percentile": 1687.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1400.78, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1400.78, "10th_percentile": 1400.78, "90th_percentile": 1400.78, "count": "0", "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": 460.35, "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": 460.35, "10th_percentile": 460.35, "90th_percentile": 460.35, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1408.02, "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": 1408.02, "10th_percentile": 1408.02, "90th_percentile": 1408.02, "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": 1039.08, "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": 1039.08, "10th_percentile": 1039.08, "90th_percentile": 1039.08, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 942.62, "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": 942.62, "10th_percentile": 942.62, "90th_percentile": 942.62, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "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 ASA", "standard_charge_dollar": 997.43, "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": 997.43, "10th_percentile": 997.43, "90th_percentile": 997.43, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1972.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1972.94, "10th_percentile": 1972.94, "90th_percentile": 1972.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $2,192.15 @ 12.8% = $280.60 due to $0.00 Claim Price", "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "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: $2,192.15 @ 12.8% = $280.60 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "5.5MM X 50MM POLY RELINE SPINAL BONE SCREW", "code_information": [ { "code": "SUP-311408", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 836.96, "maximum": 5041.95, "setting": "outpatient", "gross_charge": 5041.95, "discounted_cash": 3529.36, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2657.11, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2450.39, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 836.96, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1179.82, "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": 1179.82, "10th_percentile": 1179.82, "90th_percentile": 1179.82, "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": 1179.82, "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": 1179.82, "10th_percentile": 1179.82, "90th_percentile": 1179.82, "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": 1179.82, "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": 1179.82, "10th_percentile": 1179.82, "90th_percentile": 1179.82, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4033.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4033.56, "10th_percentile": 4033.56, "90th_percentile": 4033.56, "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": 4033.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4033.56, "10th_percentile": 4033.56, "90th_percentile": 4033.56, "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": 1376.45, "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": 1376.45, "10th_percentile": 1376.45, "90th_percentile": 1376.45, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1376.45, "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": 1376.45, "10th_percentile": 1376.45, "90th_percentile": 1376.45, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1068.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1068.39, "10th_percentile": 1068.39, "90th_percentile": 1068.39, "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": 1068.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1068.39, "10th_percentile": 1068.39, "90th_percentile": 1068.39, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 5041.95, "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 $5,041.95 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "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 $5,041.95 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5041.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3882.3, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3882.3, "10th_percentile": 3882.3, "90th_percentile": 3882.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3221.81, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3221.81, "10th_percentile": 3221.81, "90th_percentile": 3221.81, "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": 2168.04, "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": 2168.04, "10th_percentile": 2168.04, "90th_percentile": 2168.04, "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": 2520.98, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2520.98, "10th_percentile": 2520.98, "90th_percentile": 2520.98, "count": "0", "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": 3238.44, "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": 3238.44, "10th_percentile": 3238.44, "90th_percentile": 3238.44, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2294.09, "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": 2294.09, "10th_percentile": 2294.09, "90th_percentile": 2294.09, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 4537.76, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 4537.76, "10th_percentile": 4537.76, "90th_percentile": 4537.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2389.88, "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": 2389.88, "10th_percentile": 2389.88, "90th_percentile": 2389.88, "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": 1058.81, "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": 1058.81, "10th_percentile": 1058.81, "90th_percentile": 1058.81, "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": "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: $5,041.95 @ 12.8% = $645.37 due to $0.00 Claim Price", "median_amount": 645.37, "10th_percentile": 645.37, "90th_percentile": 645.37, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,041.95 @ 12.8% = $645.37 due to $0.00 Claim Price" }, { "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": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "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": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "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": 5041.95, "10th_percentile": 5041.95, "90th_percentile": 5041.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "58-80MM X10 CROSSLINK MULTI", "code_information": [ { "code": "SUP-800536", "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": "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": "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": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": "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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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 HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 HMO", "standard_charge_dollar": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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 $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% 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": 1432.79, "10th_percentile": 1432.79, "90th_percentile": 1432.79, "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": "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": 1579.4, "10th_percentile": 1579.4, "90th_percentile": 1579.4, "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": "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": 1516.09, "10th_percentile": 1516.09, "90th_percentile": 1516.09, "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": "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": 2140.19, "10th_percentile": 2140.19, "90th_percentile": 2140.19, "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": "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": 2998.86, "10th_percentile": 2998.86, "90th_percentile": 2998.86, "count": "0", "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": 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": 699.73, "10th_percentile": 699.73, "90th_percentile": 699.73, "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": "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": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 2129.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2129.19, "10th_percentile": 2129.19, "90th_percentile": 2129.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 2565.69, "10th_percentile": 2565.69, "90th_percentile": 2565.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 426.5, "10th_percentile": 426.5, "90th_percentile": 426.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "6.5 HEALIX ADVANCE BR W OCORD", "code_information": [ { "code": "SUP-312486", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 458.51, "maximum": 2762.11, "setting": "outpatient", "gross_charge": 2762.11, "discounted_cash": 1933.48, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1455.63, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1342.39, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 458.51, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 646.33, "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": 646.33, "10th_percentile": 646.33, "90th_percentile": 646.33, "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": 646.33, "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": 646.33, "10th_percentile": 646.33, "90th_percentile": 646.33, "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": 646.33, "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": 646.33, "10th_percentile": 646.33, "90th_percentile": 646.33, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2209.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2209.69, "10th_percentile": 2209.69, "90th_percentile": 2209.69, "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": 2209.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2209.69, "10th_percentile": 2209.69, "90th_percentile": 2209.69, "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": 754.06, "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": 754.06, "10th_percentile": 754.06, "90th_percentile": 754.06, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 754.06, "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": 754.06, "10th_percentile": 754.06, "90th_percentile": 754.06, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 585.29, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 585.29, "10th_percentile": 585.29, "90th_percentile": 585.29, "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": 585.29, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 585.29, "10th_percentile": 585.29, "90th_percentile": 585.29, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2762.11, "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 $2,762.11 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "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 $2,762.11 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2762.11, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2126.82, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2126.82, "10th_percentile": 2126.82, "90th_percentile": 2126.82, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1764.99, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1764.99, "10th_percentile": 1764.99, "90th_percentile": 1764.99, "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": 1187.71, "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": 1187.71, "10th_percentile": 1187.71, "90th_percentile": 1187.71, "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": 1381.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1381.06, "10th_percentile": 1381.06, "90th_percentile": 1381.06, "count": "0", "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": 1774.1, "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": 1774.1, "10th_percentile": 1774.1, "90th_percentile": 1774.1, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1256.76, "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": 1256.76, "10th_percentile": 1256.76, "90th_percentile": 1256.76, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2485.9, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2485.9, "10th_percentile": 2485.9, "90th_percentile": 2485.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1309.24, "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": 1309.24, "10th_percentile": 1309.24, "90th_percentile": 1309.24, "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": 580.04, "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": 580.04, "10th_percentile": 580.04, "90th_percentile": 580.04, "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": "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: $2,762.11 @ 12.8% = $353.55 due to $0.00 Claim Price", "median_amount": 353.55, "10th_percentile": 353.55, "90th_percentile": 353.55, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,762.11 @ 12.8% = $353.55 due to $0.00 Claim Price" }, { "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": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "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": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "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": 2762.11, "10th_percentile": 2762.11, "90th_percentile": 2762.11, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "6F 13CM INTRO SYS W/INFUS SIDE PORT SAFESHEATH II", "code_information": [ { "code": "SUP-358902", "type": "CDM" }, { "code": "C1892", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 111.21, "maximum": 669.92, "setting": "outpatient", "gross_charge": 669.92, "discounted_cash": 468.94, "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: $669.92 @ 12.8% = $85.75 due to $0.00 Claim Price", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $669.92 @ 12.8% = $85.75 due to $0.00 Claim Price" }, { "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": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "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": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "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": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 549.33, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 549.33, "10th_percentile": 549.33, "90th_percentile": 549.33, "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 $19,355 CASE RATE" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 428.08, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 428.08, "10th_percentile": 428.08, "90th_percentile": 428.08, "count": "0", "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": 140.68, "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": 140.68, "10th_percentile": 140.68, "90th_percentile": 140.68, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 334.96, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 334.96, "10th_percentile": 334.96, "90th_percentile": 334.96, "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": 111.21, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 111.21, "10th_percentile": 111.21, "90th_percentile": 111.21, "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": 325.58, "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": 325.58, "10th_percentile": 325.58, "90th_percentile": 325.58, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 430.29, "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": 430.29, "10th_percentile": 430.29, "90th_percentile": 430.29, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 304.81, "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": 304.81, "10th_percentile": 304.81, "90th_percentile": 304.81, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 602.93, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 602.93, "10th_percentile": 602.93, "90th_percentile": 602.93, "count": "0", "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": 353.05, "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": 353.05, "10th_percentile": 353.05, "90th_percentile": 353.05, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 317.54, "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": 317.54, "10th_percentile": 317.54, "90th_percentile": 317.54, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 288.07, "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": 288.07, "10th_percentile": 288.07, "90th_percentile": 288.07, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "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": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 669.92, "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 $669.92 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "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 $669.92 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 669.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 669.92, "10th_percentile": 669.92, "90th_percentile": 669.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 182.89, "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": 182.89, "10th_percentile": 182.89, "90th_percentile": 182.89, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 182.89, "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": 182.89, "10th_percentile": 182.89, "90th_percentile": 182.89, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 535.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 535.94, "10th_percentile": 535.94, "90th_percentile": 535.94, "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": 535.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 535.94, "10th_percentile": 535.94, "90th_percentile": 535.94, "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": 141.96, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 141.96, "10th_percentile": 141.96, "90th_percentile": 141.96, "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 HMO", "standard_charge_dollar": 141.96, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 141.96, "10th_percentile": 141.96, "90th_percentile": 141.96, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 156.76, "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": 156.76, "10th_percentile": 156.76, "90th_percentile": 156.76, "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 SELECT", "standard_charge_dollar": 156.76, "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": 156.76, "10th_percentile": 156.76, "90th_percentile": 156.76, "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": 156.76, "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": 156.76, "10th_percentile": 156.76, "90th_percentile": 156.76, "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." } ] } ] }, { "description": "6FR X 110CM TUOHY BORST SIDE ARM INTRODUCER FLEXOR SHUTTLE", "code_information": [ { "code": "SUP-365344", "type": "CDM" }, { "code": "C1894", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 150.65, "maximum": 907.55, "setting": "outpatient", "gross_charge": 907.55, "discounted_cash": 635.28, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 478.28, "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": 140.68, "10th_percentile": 140.68, "90th_percentile": 140.68, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 441.07, "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": 108.2, "10th_percentile": 108.2, "90th_percentile": 108.2, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $907.55 @ 12.8% = $116.17 due to $0.00 Claim Price", "median_amount": 116.17, "10th_percentile": 116.17, "90th_percentile": 116.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $907.55 @ 12.8% = $116.17 due to $0.00 Claim Price" }, { "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": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "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": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "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": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 582.92, "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": 582.92, "10th_percentile": 582.92, "90th_percentile": 582.92, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 408.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 408.4, "10th_percentile": 408.4, "90th_percentile": 408.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 190.59, "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": 190.59, "10th_percentile": 190.59, "90th_percentile": 190.59, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 390.25, "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": 390.25, "10th_percentile": 390.25, "90th_percentile": 390.25, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 430.18, "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": 430.18, "10th_percentile": 430.18, "90th_percentile": 430.18, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 412.94, "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": 412.94, "10th_percentile": 412.94, "90th_percentile": 412.94, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 579.92, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 579.92, "10th_percentile": 579.92, "90th_percentile": 579.92, "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 NM EMPLOYEES", "standard_charge_dollar": 150.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 150.65, "10th_percentile": 150.65, "90th_percentile": 150.65, "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": 453.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 453.78, "10th_percentile": 453.78, "90th_percentile": 453.78, "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": 816.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 816.8, "10th_percentile": 816.8, "90th_percentile": 816.8, "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": 744.19, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 744.19, "10th_percentile": 744.19, "90th_percentile": 744.19, "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 $19,355 CASE RATE" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 907.55, "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 $907.55 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "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 $907.55 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 907.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 907.55, "10th_percentile": 907.55, "90th_percentile": 907.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 247.76, "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": 247.76, "10th_percentile": 247.76, "90th_percentile": 247.76, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 247.76, "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": 247.76, "10th_percentile": 247.76, "90th_percentile": 247.76, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 726.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 726.04, "10th_percentile": 726.04, "90th_percentile": 726.04, "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": 726.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 726.04, "10th_percentile": 726.04, "90th_percentile": 726.04, "count": "0", "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": 192.31, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 192.31, "10th_percentile": 192.31, "90th_percentile": 192.31, "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": 192.31, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 192.31, "10th_percentile": 192.31, "90th_percentile": 192.31, "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 BLUECHOICE SELECT", "standard_charge_dollar": 212.37, "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": 212.37, "10th_percentile": 212.37, "90th_percentile": 212.37, "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": 212.37, "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": 212.37, "10th_percentile": 212.37, "90th_percentile": 212.37, "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": 212.37, "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": 212.37, "10th_percentile": 212.37, "90th_percentile": 212.37, "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." } ] } ] }, { "description": "ACCESSORY KT ARTHSCP ANT CRUC LIG ACL DISP", "code_information": [ { "code": "SUP-126551", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 791.84, "maximum": 4770.12, "setting": "outpatient", "gross_charge": 4770.12, "discounted_cash": 3339.08, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 791.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2318.28, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2513.85, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1116.21, "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": 1116.21, "10th_percentile": 1116.21, "90th_percentile": 1116.21, "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": 1116.21, "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": 1116.21, "10th_percentile": 1116.21, "90th_percentile": 1116.21, "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": 1116.21, "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": 1116.21, "10th_percentile": 1116.21, "90th_percentile": 1116.21, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3816.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3816.1, "10th_percentile": 3816.1, "90th_percentile": 3816.1, "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": 3816.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3816.1, "10th_percentile": 3816.1, "90th_percentile": 3816.1, "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": 1302.24, "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": 1302.24, "10th_percentile": 1302.24, "90th_percentile": 1302.24, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1302.24, "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": 1302.24, "10th_percentile": 1302.24, "90th_percentile": 1302.24, "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 HMO", "standard_charge_dollar": 1010.79, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1010.79, "10th_percentile": 1010.79, "90th_percentile": 1010.79, "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 HMO", "standard_charge_dollar": 1010.79, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1010.79, "10th_percentile": 1010.79, "90th_percentile": 1010.79, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4770.12, "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 $4,770.12 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "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 $4,770.12 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4770.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2051.15, "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": 2051.15, "10th_percentile": 2051.15, "90th_percentile": 2051.15, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2261.04, "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": 2261.04, "10th_percentile": 2261.04, "90th_percentile": 2261.04, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2170.4, "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": 2170.4, "10th_percentile": 2170.4, "90th_percentile": 2170.4, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3063.85, "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": 3063.85, "10th_percentile": 3063.85, "90th_percentile": 3063.85, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 4293.11, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 4293.11, "10th_percentile": 4293.11, "90th_percentile": 4293.11, "count": "0", "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": 1001.73, "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": 1001.73, "10th_percentile": 1001.73, "90th_percentile": 1001.73, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2385.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2385.06, "10th_percentile": 2385.06, "90th_percentile": 2385.06, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 3048.11, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3048.11, "10th_percentile": 3048.11, "90th_percentile": 3048.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3672.99, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3672.99, "10th_percentile": 3672.99, "90th_percentile": 3672.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $4,770.12 @ 12.8% = $610.58 due to $0.00 Claim Price", "median_amount": 610.58, "10th_percentile": 610.58, "90th_percentile": 610.58, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,770.12 @ 12.8% = $610.58 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "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": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "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": 4770.12, "10th_percentile": 4770.12, "90th_percentile": 4770.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ACETAMINOPHEN 32 MG/ML ORAL SUSP", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "RX-181460", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00121-1781-05", "type": "NDC" } ], "standard_charges": [ { "minimum": 1.37, "maximum": 8.25, "setting": "outpatient", "gross_charge": 8.25, "discounted_cash": 5.77, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "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": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "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": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "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": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "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": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "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 BCBS PPO", "standard_charge_dollar": 2.25, "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": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2.25, "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": 2.25, "10th_percentile": 2.25, "90th_percentile": 2.25, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 6.6, "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": 6.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6.6, "10th_percentile": 6.6, "90th_percentile": 6.6, "count": "0", "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": 1.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "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": 1.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1.75, "10th_percentile": 1.75, "90th_percentile": 1.75, "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", "standard_charge_dollar": 3.55, "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": 3.55, "10th_percentile": 3.55, "90th_percentile": 3.55, "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": 1.37, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1.37, "10th_percentile": 1.37, "90th_percentile": 1.37, "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 ASA", "standard_charge_dollar": 3.75, "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": 3.75, "10th_percentile": 3.75, "90th_percentile": 3.75, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4.35, "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": 4.35, "10th_percentile": 4.35, "90th_percentile": 4.35, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3.91, "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": 3.91, "10th_percentile": 3.91, "90th_percentile": 3.91, "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 BROAD", "standard_charge_dollar": 4.01, "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": 4.01, "10th_percentile": 4.01, "90th_percentile": 4.01, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1.73, "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": 1.73, "10th_percentile": 1.73, "90th_percentile": 1.73, "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": 5.3, "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": 5.3, "10th_percentile": 5.3, "90th_percentile": 5.3, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 7.43, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 7.43, "10th_percentile": 7.43, "90th_percentile": 7.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 5.27, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 5.27, "10th_percentile": 5.27, "90th_percentile": 5.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 6.77, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 6.77, "10th_percentile": 6.77, "90th_percentile": 6.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 4.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4.13, "10th_percentile": 4.13, "90th_percentile": 4.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1.73, "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": 1.73, "10th_percentile": 1.73, "90th_percentile": 1.73, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 3.71, "10th_percentile": 3.71, "90th_percentile": 3.71, "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 OPTIONS", "standard_charge_dollar": 1.92, "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": 1.92, "10th_percentile": 1.92, "90th_percentile": 1.92, "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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1.82, "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": 1.82, "10th_percentile": 1.82, "90th_percentile": 1.82, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 8.25, "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 $8.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 8.25, "10th_percentile": 8.25, "90th_percentile": 8.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $8.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "ACETAMINOPHEN 500 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-102", "type": "CDM" }, { "code": "CHRG1625", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "24385-0484-71", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.33, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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 HMO", "standard_charge_dollar": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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 BLUECHOICE SELECT", "standard_charge_dollar": 0.42, "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": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.42, "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": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 0.86, "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": 0.86, "10th_percentile": 0.86, "90th_percentile": 0.86, "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 ASA", "standard_charge_dollar": 0.91, "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": 0.91, "10th_percentile": 0.91, "90th_percentile": 0.91, "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 NM EMPLOYEES", "standard_charge_dollar": 0.33, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.33, "10th_percentile": 0.33, "90th_percentile": 0.33, "count": "0", "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": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 0.44, "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": 0.44, "10th_percentile": 0.44, "90th_percentile": 0.44, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2.0, "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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "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 $2.00 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": "NLFH BCBS PPO", "standard_charge_dollar": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 0.97, "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": 0.97, "10th_percentile": 0.97, "90th_percentile": 0.97, "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": 1.64, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.64, "10th_percentile": 1.64, "90th_percentile": 1.64, "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": 1.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "count": "0", "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": 1.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 1.8, "90th_percentile": 1.8, "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": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1.28, "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": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "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": 0.95, "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": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1.05, "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": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "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." } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 14208.92, "maximum": 28810.74, "setting": "inpatient", "gross_charge": 54352.5, "discounted_cash": 38046.75, "payers_information": [ { "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, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 54352.5, "10th_percentile": 54352.5, "90th_percentile": 54352.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services - OON; 100% Billed", "median_amount": 54352.5, "10th_percentile": 54352.5, "90th_percentile": 54352.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; 100% Billed", "median_amount": 54352.5, "10th_percentile": 54352.5, "90th_percentile": 54352.5, "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, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 9022.52, "10th_percentile": 9022.52, "90th_percentile": 9022.52, "count": "1 through 10", "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 drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 46199.63, "10th_percentile": 46199.63, "90th_percentile": 46199.63, "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, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 39133.8, "10th_percentile": 39133.8, "90th_percentile": 39133.8, "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.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; Inpatient Services; 50% Billed", "median_amount": 27176.25, "10th_percentile": 27176.25, "90th_percentile": 27176.25, "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.746578646; Using historical claim(s); 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": 16523.16, "10th_percentile": 16523.16, "90th_percentile": 16523.16, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; IP Services; 65% Billed", "median_amount": 35329.13, "10th_percentile": 35329.13, "90th_percentile": 35329.13, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 28810.74, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28810.74, "10th_percentile": 28810.74, "90th_percentile": 28810.74, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 21923.49, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21923.49, "10th_percentile": 21923.49, "90th_percentile": 21923.49, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 24676.81, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 12,458.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE STOP LOSS & LESSOR OF 9*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24676.81, "10th_percentile": 24676.81, "90th_percentile": 24676.81, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 23523.98, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 11,876.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE PREF STOP LOSS & LESSOR*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23523.98, "10th_percentile": 23523.98, "90th_percentile": 23523.98, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 23062.45, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 11,643.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE SELECT STOP LOSS & LESS*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 23062.45, "10th_percentile": 23062.45, "90th_percentile": 23062.45, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 28810.74, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 28810.74, "10th_percentile": 28810.74, "90th_percentile": 28810.74, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 21923.49, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.9808, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 21923.49, "10th_percentile": 21923.49, "90th_percentile": 21923.49, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 14208.92, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $18,006.81; Total: $18,006.81", "median_amount": 18006.81, "10th_percentile": 18006.81, "90th_percentile": 18006.81, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Base payment: $18,006.81; Total: $18,006.81" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_dollar": 14208.92, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $16,506.16; Total: $16,506.16", "median_amount": 16506.16, "10th_percentile": 16506.16, "90th_percentile": 16506.16, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $16,506.16; Total: $16,506.16" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_dollar": 14208.92, "standard_charge_algorithm": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $15,397.57; Total: $15,397.57 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 15397.57, "10th_percentile": 15397.57, "90th_percentile": 15397.57, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.746578646; Using historical claim(s); Scope: All Financial Classes; Cases: 1; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.98, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $15,397.57; Total: $15,397.57 Paid at contractual rate, which is 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": "ACYCLOVIR 5 % TOP OINT", "drug_information": { "unit": 30.0, "type": "GR" }, "code_information": [ { "code": "RX-8968", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "72578-0082-06", "type": "NDC" } ], "standard_charges": [ { "minimum": 45.4, "maximum": 273.5, "setting": "outpatient", "gross_charge": 273.5, "discounted_cash": 191.45, "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": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "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": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "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": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "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": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "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": 218.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 218.8, "10th_percentile": 218.8, "90th_percentile": 218.8, "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": 218.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 218.8, "10th_percentile": 218.8, "90th_percentile": 218.8, "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 HMO", "standard_charge_dollar": 57.95, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 57.95, "10th_percentile": 57.95, "90th_percentile": 57.95, "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 HMO", "standard_charge_dollar": 57.95, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 57.95, "10th_percentile": 57.95, "90th_percentile": 57.95, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 63.64, "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": 63.64, "10th_percentile": 63.64, "90th_percentile": 63.64, "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": 273.5, "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 $273.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "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 $273.50 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": 60.2, "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": 60.2, "10th_percentile": 60.2, "90th_percentile": 60.2, "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": 57.33, "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": 57.33, "10th_percentile": 57.33, "90th_percentile": 57.33, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 123.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 123.08, "10th_percentile": 123.08, "90th_percentile": 123.08, "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": 74.69, "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": 74.69, "10th_percentile": 74.69, "90th_percentile": 74.69, "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": 136.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 136.75, "10th_percentile": 136.75, "90th_percentile": 136.75, "count": "0", "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": 129.64, "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": 129.64, "10th_percentile": 129.64, "90th_percentile": 129.64, "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": 224.27, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 224.27, "10th_percentile": 224.27, "90th_percentile": 224.27, "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": 174.77, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 174.77, "10th_percentile": 174.77, "90th_percentile": 174.77, "count": "0", "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": 57.44, "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": 57.44, "10th_percentile": 57.44, "90th_percentile": 57.44, "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 HMO/PPO", "standard_charge_dollar": 144.13, "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": 144.13, "10th_percentile": 144.13, "90th_percentile": 144.13, "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 PPO", "standard_charge_dollar": 246.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 246.15, "10th_percentile": 246.15, "90th_percentile": 246.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 273.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 273.5, "10th_percentile": 273.5, "90th_percentile": 273.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 175.67, "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": 175.67, "10th_percentile": 175.67, "90th_percentile": 175.67, "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 BROAD", "standard_charge_dollar": 132.92, "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": 132.92, "10th_percentile": 132.92, "90th_percentile": 132.92, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 124.44, "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": 124.44, "10th_percentile": 124.44, "90th_percentile": 124.44, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 74.69, "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": 74.69, "10th_percentile": 74.69, "90th_percentile": 74.69, "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", "standard_charge_dollar": 117.61, "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": 117.61, "10th_percentile": 117.61, "90th_percentile": 117.61, "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": 45.4, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 45.4, "10th_percentile": 45.4, "90th_percentile": 45.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" } ] } ] }, { "description": "ACYCLOVIR SODIUM 50 MG/ML IV SOLN", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "RX-23128", "type": "CDM" }, { "code": "J0133", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "65219-0622-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.78, "maximum": 22.75, "setting": "outpatient", "gross_charge": 22.75, "discounted_cash": 15.92, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 4.82, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4.82, "10th_percentile": 4.82, "90th_percentile": 4.82, "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 HMO", "standard_charge_dollar": 4.82, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4.82, "10th_percentile": 4.82, "90th_percentile": 4.82, "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": 18.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "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": 18.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "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": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "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": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 22.75, "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 $22.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $22.75 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 14.54, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 14.54, "10th_percentile": 14.54, "90th_percentile": 14.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 11.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 11.38, "10th_percentile": 11.38, "90th_percentile": 11.38, "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": 20.48, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 20.48, "10th_percentile": 20.48, "90th_percentile": 20.48, "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 NM EMPLOYEES", "standard_charge_dollar": 3.78, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3.78, "10th_percentile": 3.78, "90th_percentile": 3.78, "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 ASA", "standard_charge_dollar": 10.35, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 10.35, "10th_percentile": 10.35, "90th_percentile": 10.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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": 18.66, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 18.66, "10th_percentile": 18.66, "90th_percentile": 18.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "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": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "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": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "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": 22.75, "10th_percentile": 22.75, "90th_percentile": 22.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADAPTA S PACEMAKER", "code_information": [ { "code": "SUP-117685", "type": "CDM" }, { "code": "C1785", "type": "HCPCS" }, { "code": "0275", "type": "RC" } ], "standard_charges": [ { "minimum": 5477.38, "maximum": 32996.24, "setting": "outpatient", "gross_charge": 32996.24, "discounted_cash": 23097.37, "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: $32,996.24 @ 12.8% = $4,223.52 due to $0.00 Claim Price", "median_amount": 4223.52, "10th_percentile": 4223.52, "90th_percentile": 4223.52, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32,996.24 @ 12.8% = $4,223.52 due to $0.00 Claim Price" }, { "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": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "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": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "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": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 7721.12, "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": 7721.12, "10th_percentile": 7721.12, "90th_percentile": 7721.12, "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": 7721.12, "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": 7721.12, "10th_percentile": 7721.12, "90th_percentile": 7721.12, "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 SELECT", "standard_charge_dollar": 7721.12, "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": 7721.12, "10th_percentile": 7721.12, "90th_percentile": 7721.12, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 9007.97, "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": 9007.97, "10th_percentile": 9007.97, "90th_percentile": 9007.97, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 9007.97, "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": 9007.97, "10th_percentile": 9007.97, "90th_percentile": 9007.97, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 26396.99, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 26396.99, "10th_percentile": 26396.99, "90th_percentile": 26396.99, "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": 26396.99, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 26396.99, "10th_percentile": 26396.99, "90th_percentile": 26396.99, "count": "0", "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": 6991.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 6991.9, "10th_percentile": 6991.9, "90th_percentile": 6991.9, "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": 6991.9, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 6991.9, "10th_percentile": 6991.9, "90th_percentile": 6991.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 32996.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 32996.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 32996.24, "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 $32,996.24 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "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 $32,996.24 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": 32996.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 32996.24, "10th_percentile": 32996.24, "90th_percentile": 32996.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 21084.6, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 21084.6, "10th_percentile": 21084.6, "90th_percentile": 21084.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 16498.12, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 16498.12, "10th_percentile": 16498.12, "90th_percentile": 16498.12, "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": 29696.62, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 29696.62, "10th_percentile": 29696.62, "90th_percentile": 29696.62, "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 NM EMPLOYEES", "standard_charge_dollar": 5477.38, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 5477.38, "10th_percentile": 5477.38, "90th_percentile": 5477.38, "count": "0", "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": 21193.48, "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": 21193.48, "10th_percentile": 21193.48, "90th_percentile": 21193.48, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 15013.29, "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": 15013.29, "10th_percentile": 15013.29, "90th_percentile": 15013.29, "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": 14188.38, "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": 14188.38, "10th_percentile": 14188.38, "90th_percentile": 14188.38, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 16036.17, "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": 16036.17, "10th_percentile": 16036.17, "90th_percentile": 16036.17, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 6929.21, "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": 6929.21, "10th_percentile": 6929.21, "90th_percentile": 6929.21, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 15640.22, "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": 15640.22, "10th_percentile": 15640.22, "90th_percentile": 15640.22, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 17389.02, "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": 17389.02, "10th_percentile": 17389.02, "90th_percentile": 17389.02, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 25407.1, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 25407.1, "10th_percentile": 25407.1, "90th_percentile": 25407.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" } ] } ] }, { "description": "ADAPTER CATHETER/SYRINGE/LUER STERILE", "code_information": [ { "code": "SUP-393490", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1.73, "maximum": 10.4, "setting": "outpatient", "gross_charge": 10.4, "discounted_cash": 7.28, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 8.32, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8.32, "10th_percentile": 8.32, "90th_percentile": 8.32, "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": 8.32, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8.32, "10th_percentile": 8.32, "90th_percentile": 8.32, "count": "0", "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": 2.84, "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": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2.84, "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": 2.84, "10th_percentile": 2.84, "90th_percentile": 2.84, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.2, "10th_percentile": 2.2, "90th_percentile": 2.2, "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 HMO", "standard_charge_dollar": 2.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.2, "10th_percentile": 2.2, "90th_percentile": 2.2, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 10.4, "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 $10.40 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "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 $10.40 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": 2.29, "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": 2.29, "10th_percentile": 2.29, "90th_percentile": 2.29, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4.68, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 4.68, "10th_percentile": 4.68, "90th_percentile": 4.68, "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 OPTIONS", "standard_charge_dollar": 2.42, "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": 2.42, "10th_percentile": 2.42, "90th_percentile": 2.42, "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 BLUECHOICE SELECT", "standard_charge_dollar": 2.18, "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": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 6.68, "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": 6.68, "10th_percentile": 6.68, "90th_percentile": 6.68, "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 BROAD", "standard_charge_dollar": 5.05, "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": 5.05, "10th_percentile": 5.05, "90th_percentile": 5.05, "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": 8.53, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 8.53, "10th_percentile": 8.53, "90th_percentile": 8.53, "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": 5.2, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5.2, "10th_percentile": 5.2, "90th_percentile": 5.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1.73, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1.73, "10th_percentile": 1.73, "90th_percentile": 1.73, "count": "0", "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": 4.93, "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": 4.93, "10th_percentile": 4.93, "90th_percentile": 4.93, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 4.73, "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": 4.73, "10th_percentile": 4.73, "90th_percentile": 4.73, "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": 5.48, "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": 5.48, "10th_percentile": 5.48, "90th_percentile": 5.48, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 10.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2.18, "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": 2.18, "10th_percentile": 2.18, "90th_percentile": 2.18, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6.65, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6.65, "10th_percentile": 6.65, "90th_percentile": 6.65, "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": 4.47, "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": 4.47, "10th_percentile": 4.47, "90th_percentile": 4.47, "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": 9.36, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 9.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "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": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "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": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "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": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADAPTER PHOTONGUIDE ILLUMINATED RETRACTOR SYSTEM INVUITY", "code_information": [ { "code": "SUP-416494", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 432.31, "maximum": 2604.27, "setting": "outpatient", "gross_charge": 2604.27, "discounted_cash": 1822.99, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2083.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2083.42, "10th_percentile": 2083.42, "90th_percentile": 2083.42, "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": 2083.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2083.42, "10th_percentile": 2083.42, "90th_percentile": 2083.42, "count": "0", "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": 711.23, "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": 711.23, "10th_percentile": 711.23, "90th_percentile": 711.23, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 711.23, "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": 711.23, "10th_percentile": 711.23, "90th_percentile": 711.23, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 551.84, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 551.84, "10th_percentile": 551.84, "90th_percentile": 551.84, "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 HMO", "standard_charge_dollar": 551.84, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 551.84, "10th_percentile": 551.84, "90th_percentile": 551.84, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2604.27, "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 $2,604.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "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 $2,604.27 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 573.2, "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": 573.2, "10th_percentile": 573.2, "90th_percentile": 573.2, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1171.92, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1171.92, "10th_percentile": 1171.92, "90th_percentile": 1171.92, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 606.01, "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": 606.01, "10th_percentile": 606.01, "90th_percentile": 606.01, "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 BLUECHOICE SELECT", "standard_charge_dollar": 545.85, "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": 545.85, "10th_percentile": 545.85, "90th_percentile": 545.85, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1672.72, "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": 1672.72, "10th_percentile": 1672.72, "90th_percentile": 1672.72, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1265.68, "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": 1265.68, "10th_percentile": 1265.68, "90th_percentile": 1265.68, "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": 2135.5, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2135.5, "10th_percentile": 2135.5, "90th_percentile": 2135.5, "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": 1302.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1302.14, "10th_percentile": 1302.14, "90th_percentile": 1302.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 432.31, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 432.31, "10th_percentile": 432.31, "90th_percentile": 432.31, "count": "0", "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": 1234.42, "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": 1234.42, "10th_percentile": 1234.42, "90th_percentile": 1234.42, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1184.94, "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": 1184.94, "10th_percentile": 1184.94, "90th_percentile": 1184.94, "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": 1372.45, "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": 1372.45, "10th_percentile": 1372.45, "90th_percentile": 1372.45, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2604.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 546.9, "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": 546.9, "10th_percentile": 546.9, "90th_percentile": 546.9, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1664.13, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1664.13, "10th_percentile": 1664.13, "90th_percentile": 1664.13, "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": 1119.84, "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": 1119.84, "10th_percentile": 1119.84, "90th_percentile": 1119.84, "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": 2343.84, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2343.84, "10th_percentile": 2343.84, "90th_percentile": 2343.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "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": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "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": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "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": 2604.27, "10th_percentile": 2604.27, "90th_percentile": 2604.27, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADAPTER PIN APEX SHRT 3-6MM", "code_information": [ { "code": "SUP-350041", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 819.69, "maximum": 4937.88, "setting": "outpatient", "gross_charge": 4937.88, "discounted_cash": 3456.52, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3950.3, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3950.3, "10th_percentile": 3950.3, "90th_percentile": 3950.3, "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": 1348.54, "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": 1348.54, "10th_percentile": 1348.54, "90th_percentile": 1348.54, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1046.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1046.34, "10th_percentile": 1046.34, "90th_percentile": 1046.34, "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 HMO", "standard_charge_dollar": 1046.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1046.34, "10th_percentile": 1046.34, "90th_percentile": 1046.34, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 1086.83, "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": 1086.83, "10th_percentile": 1086.83, "90th_percentile": 1086.83, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2222.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2222.05, "10th_percentile": 2222.05, "90th_percentile": 2222.05, "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 OPTIONS", "standard_charge_dollar": 1149.04, "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": 1149.04, "10th_percentile": 1149.04, "90th_percentile": 1149.04, "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 BLUECHOICE SELECT", "standard_charge_dollar": 1034.98, "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": 1034.98, "10th_percentile": 1034.98, "90th_percentile": 1034.98, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 819.69, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 819.69, "10th_percentile": 819.69, "90th_percentile": 819.69, "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 ASA", "standard_charge_dollar": 2246.74, "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": 2246.74, "10th_percentile": 2246.74, "90th_percentile": 2246.74, "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": 2123.29, "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": 2123.29, "10th_percentile": 2123.29, "90th_percentile": 2123.29, "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 ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "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": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "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": 3950.3, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3950.3, "10th_percentile": 3950.3, "90th_percentile": 3950.3, "count": "0", "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": 1348.54, "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": 1348.54, "10th_percentile": 1348.54, "90th_percentile": 1348.54, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 4937.88, "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 $4,937.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "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 $4,937.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2468.94, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2468.94, "10th_percentile": 2468.94, "90th_percentile": 2468.94, "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": 4444.09, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 4444.09, "10th_percentile": 4444.09, "90th_percentile": 4444.09, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3155.31, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3155.31, "10th_percentile": 3155.31, "90th_percentile": 3155.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4049.06, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 4049.06, "10th_percentile": 4049.06, "90th_percentile": 4049.06, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 2399.81, "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": 2399.81, "10th_percentile": 2399.81, "90th_percentile": 2399.81, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2340.56, "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": 2340.56, "10th_percentile": 2340.56, "90th_percentile": 2340.56, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3171.6, "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": 3171.6, "10th_percentile": 3171.6, "90th_percentile": 3171.6, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4937.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1036.95, "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": 1036.95, "10th_percentile": 1036.95, "90th_percentile": 1036.95, "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 HMO/PPO", "standard_charge_dollar": 2602.26, "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": 2602.26, "10th_percentile": 2602.26, "90th_percentile": 2602.26, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "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": 4937.88, "10th_percentile": 4937.88, "90th_percentile": 4937.88, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADHESIVE REINF STPL LN GEL PERI-STRIPS DRY", "code_information": [ { "code": "SUP-114877", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 21.83, "maximum": 131.53, "setting": "outpatient", "gross_charge": 131.53, "discounted_cash": 92.07, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 35.92, "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": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 35.92, "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": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 27.87, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 27.87, "10th_percentile": 27.87, "90th_percentile": 27.87, "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 HMO", "standard_charge_dollar": 27.87, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 27.87, "10th_percentile": 27.87, "90th_percentile": 27.87, "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": 105.22, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 105.22, "10th_percentile": 105.22, "90th_percentile": 105.22, "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": 105.22, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 105.22, "10th_percentile": 105.22, "90th_percentile": 105.22, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 131.53, "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 $131.53 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "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 $131.53 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 BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.61, "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": 30.61, "10th_percentile": 30.61, "90th_percentile": 30.61, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 28.95, "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": 28.95, "10th_percentile": 28.95, "90th_percentile": 28.95, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 59.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 59.19, "10th_percentile": 59.19, "90th_percentile": 59.19, "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": 27.57, "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": 27.57, "10th_percentile": 27.57, "90th_percentile": 27.57, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 118.38, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 118.38, "10th_percentile": 118.38, "90th_percentile": 118.38, "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": 65.77, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 65.77, "10th_percentile": 65.77, "90th_percentile": 65.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 107.85, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 107.85, "10th_percentile": 107.85, "90th_percentile": 107.85, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 63.92, "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": 63.92, "10th_percentile": 63.92, "90th_percentile": 63.92, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 84.05, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 84.05, "10th_percentile": 84.05, "90th_percentile": 84.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 21.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 21.83, "10th_percentile": 21.83, "90th_percentile": 21.83, "count": "0", "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": 84.48, "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": 84.48, "10th_percentile": 84.48, "90th_percentile": 84.48, "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": 69.32, "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": 69.32, "10th_percentile": 69.32, "90th_percentile": 69.32, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 62.35, "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": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "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": 27.62, "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": 27.62, "10th_percentile": 27.62, "90th_percentile": 27.62, "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": 56.56, "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": 56.56, "10th_percentile": 56.56, "90th_percentile": 56.56, "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 ASA", "standard_charge_dollar": 59.85, "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": 59.85, "10th_percentile": 59.85, "90th_percentile": 59.85, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "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": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "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": 131.53, "10th_percentile": 131.53, "90th_percentile": 131.53, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT FEM OFST REV 3MM", "code_information": [ { "code": "SUP-143568", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2374.98, "maximum": 14307.13, "setting": "outpatient", "gross_charge": 14307.13, "discounted_cash": 10014.99, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2374.98, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $14,307.13 @ 12.8% = $1,831.31 due to $0.00 Claim Price", "median_amount": 1831.31, "10th_percentile": 1831.31, "90th_percentile": 1831.31, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,307.13 @ 12.8% = $1,831.31 due to $0.00 Claim Price" }, { "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": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "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": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "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": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "count": "0", "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": 11445.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11445.7, "10th_percentile": 11445.7, "90th_percentile": 11445.7, "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": 11445.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11445.7, "10th_percentile": 11445.7, "90th_percentile": 11445.7, "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": 3031.68, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3031.68, "10th_percentile": 3031.68, "90th_percentile": 3031.68, "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 HMO", "standard_charge_dollar": 3031.68, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3031.68, "10th_percentile": 3031.68, "90th_percentile": 3031.68, "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": 3905.85, "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": 3905.85, "10th_percentile": 3905.85, "90th_percentile": 3905.85, "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": 3905.85, "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": 3905.85, "10th_percentile": 3905.85, "90th_percentile": 3905.85, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 14307.13, "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 $14,307.13 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "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 $14,307.13 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 14307.13, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 14307.13, "10th_percentile": 14307.13, "90th_percentile": 14307.13, "count": "0", "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": 7539.86, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 9142.26, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 9142.26, "10th_percentile": 9142.26, "90th_percentile": 9142.26, "count": "0", "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": 3004.5, "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": 3004.5, "10th_percentile": 3004.5, "90th_percentile": 3004.5, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 9189.47, "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": 9189.47, "10th_percentile": 9189.47, "90th_percentile": 9189.47, "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": 6781.58, "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": 6781.58, "10th_percentile": 6781.58, "90th_percentile": 6781.58, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 6509.74, "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": 6509.74, "10th_percentile": 6509.74, "90th_percentile": 6509.74, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 11016.49, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 11016.49, "10th_percentile": 11016.49, "90th_percentile": 11016.49, "count": "0", "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": 12876.42, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 12876.42, "10th_percentile": 12876.42, "90th_percentile": 12876.42, "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": 7153.57, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 7153.57, "10th_percentile": 7153.57, "90th_percentile": 7153.57, "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 BROAD", "standard_charge_dollar": 6953.27, "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": 6953.27, "10th_percentile": 6953.27, "90th_percentile": 6953.27, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 6152.07, "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": 6152.07, "10th_percentile": 6152.07, "90th_percentile": 6152.07, "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 OPTIONS", "standard_charge_dollar": 3347.87, "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": 3347.87, "10th_percentile": 3347.87, "90th_percentile": 3347.87, "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 SELECT", "standard_charge_dollar": 3347.87, "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": 3347.87, "10th_percentile": 3347.87, "90th_percentile": 3347.87, "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": 3347.87, "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": 3347.87, "10th_percentile": 3347.87, "90th_percentile": 3347.87, "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." } ] } ] }, { "description": "ADPT HUM HD 7DIAX170LG RVRS FX HMROPRSTHS AEQ", "code_information": [ { "code": "SUP-314004", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 4075.65, "maximum": 24552.08, "setting": "outpatient", "gross_charge": 24552.08, "discounted_cash": 17186.46, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 12938.95, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 15769.8, "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": 15769.8, "10th_percentile": 15769.8, "90th_percentile": 15769.8, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 11637.69, "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": 11637.69, "10th_percentile": 11637.69, "90th_percentile": 11637.69, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 4075.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $24,552.08 @ 12.8% = $3,142.67 due to $0.00 Claim Price", "median_amount": 3142.67, "10th_percentile": 3142.67, "90th_percentile": 3142.67, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $24,552.08 @ 12.8% = $3,142.67 due to $0.00 Claim Price" }, { "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": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "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": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "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": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "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 PPO", "standard_charge_dollar": 6702.72, "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": 6702.72, "10th_percentile": 6702.72, "90th_percentile": 6702.72, "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": 6702.72, "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": 6702.72, "10th_percentile": 6702.72, "90th_percentile": 6702.72, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 19641.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 19641.66, "10th_percentile": 19641.66, "90th_percentile": 19641.66, "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": 19641.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 19641.66, "10th_percentile": 19641.66, "90th_percentile": 19641.66, "count": "0", "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": 5202.59, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5202.59, "10th_percentile": 5202.59, "90th_percentile": 5202.59, "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": 5202.59, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5202.59, "10th_percentile": 5202.59, "90th_percentile": 5202.59, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 24552.08, "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 $24,552.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "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 $24,552.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 24552.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 24552.08, "10th_percentile": 24552.08, "90th_percentile": 24552.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 18905.1, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 18905.1, "10th_percentile": 18905.1, "90th_percentile": 18905.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 5155.94, "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": 5155.94, "10th_percentile": 5155.94, "90th_percentile": 5155.94, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 22096.87, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 22096.87, "10th_percentile": 22096.87, "90th_percentile": 22096.87, "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": 11171.2, "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": 11171.2, "10th_percentile": 11171.2, "90th_percentile": 11171.2, "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 BROAD", "standard_charge_dollar": 11932.31, "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": 11932.31, "10th_percentile": 11932.31, "90th_percentile": 11932.31, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 15688.78, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 15688.78, "10th_percentile": 15688.78, "90th_percentile": 15688.78, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 12276.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 12276.04, "10th_percentile": 12276.04, "90th_percentile": 12276.04, "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", "standard_charge_dollar": 10557.39, "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": 10557.39, "10th_percentile": 10557.39, "90th_percentile": 10557.39, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 5745.19, "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": 5745.19, "10th_percentile": 5745.19, "90th_percentile": 5745.19, "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": 5745.19, "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": 5745.19, "10th_percentile": 5745.19, "90th_percentile": 5745.19, "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 SELECT", "standard_charge_dollar": 5745.19, "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": 5745.19, "10th_percentile": 5745.19, "90th_percentile": 5745.19, "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." } ] } ] }, { "description": "ADPT OFST DURAC STD 4MM COCR", "code_information": [ { "code": "SUP-1649", "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": "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": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 975.8, "10th_percentile": 975.8, "90th_percentile": 975.8, "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: $7,623.42 @ 12.8% = $975.80 due to $0.00 Claim Price" }, { "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": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "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": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "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": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "count": "0", "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": 6098.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6098.74, "10th_percentile": 6098.74, "90th_percentile": 6098.74, "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": 6098.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6098.74, "10th_percentile": 6098.74, "90th_percentile": 6098.74, "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": 1615.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1615.4, "10th_percentile": 1615.4, "90th_percentile": 1615.4, "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 HMO", "standard_charge_dollar": 1615.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1615.4, "10th_percentile": 1615.4, "90th_percentile": 1615.4, "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": 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": 2081.19, "10th_percentile": 2081.19, "90th_percentile": 2081.19, "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": 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": 2081.19, "10th_percentile": 2081.19, "90th_percentile": 2081.19, "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": "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": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "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 $7,623.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7623.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 7623.42, "10th_percentile": 7623.42, "90th_percentile": 7623.42, "count": "0", "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": 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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 4871.37, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4871.37, "10th_percentile": 4871.37, "90th_percentile": 4871.37, "count": "0", "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": 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": 1600.92, "10th_percentile": 1600.92, "90th_percentile": 1600.92, "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": "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": 4896.52, "10th_percentile": 4896.52, "90th_percentile": 4896.52, "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": 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": 3613.5, "10th_percentile": 3613.5, "90th_percentile": 3613.5, "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": "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": 3468.66, "10th_percentile": 3468.66, "90th_percentile": 3468.66, "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": "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": 5870.03, "10th_percentile": 5870.03, "90th_percentile": 5870.03, "count": "0", "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": 6861.08, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6861.08, "10th_percentile": 6861.08, "90th_percentile": 6861.08, "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": 3811.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3811.71, "10th_percentile": 3811.71, "90th_percentile": 3811.71, "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 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": 3704.98, "10th_percentile": 3704.98, "90th_percentile": 3704.98, "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": "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": 3278.07, "10th_percentile": 3278.07, "90th_percentile": 3278.07, "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 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": 1783.88, "10th_percentile": 1783.88, "90th_percentile": 1783.88, "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 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": 1783.88, "10th_percentile": 1783.88, "90th_percentile": 1783.88, "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": 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": 1783.88, "10th_percentile": 1783.88, "90th_percentile": 1783.88, "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." } ] } ] }, { "description": "ADPT PERF 0.25IN STRL", "code_information": [ { "code": "SUP-153803", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 14.08, "maximum": 84.84, "setting": "outpatient", "gross_charge": 84.84, "discounted_cash": 59.39, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 67.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 67.87, "10th_percentile": 67.87, "90th_percentile": 67.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 23.17, "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": 23.17, "10th_percentile": 23.17, "90th_percentile": 23.17, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 17.98, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 17.98, "10th_percentile": 17.98, "90th_percentile": 17.98, "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": 14.08, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.08, "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 ASA", "standard_charge_dollar": 38.6, "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": 38.6, "10th_percentile": 38.6, "90th_percentile": 38.6, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 36.48, "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": 36.48, "10th_percentile": 36.48, "90th_percentile": 36.48, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "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": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "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": 67.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 67.87, "10th_percentile": 67.87, "90th_percentile": 67.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 17.98, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 17.98, "10th_percentile": 17.98, "90th_percentile": 17.98, "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": 23.17, "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": 23.17, "10th_percentile": 23.17, "90th_percentile": 23.17, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 84.84, "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 $84.84 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "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 $84.84 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 18.67, "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": 18.67, "10th_percentile": 18.67, "90th_percentile": 18.67, "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": 17.78, "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": 17.78, "10th_percentile": 17.78, "90th_percentile": 17.78, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 19.74, "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": 19.74, "10th_percentile": 19.74, "90th_percentile": 19.74, "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": 38.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 38.18, "10th_percentile": 38.18, "90th_percentile": 38.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 42.42, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 42.42, "10th_percentile": 42.42, "90th_percentile": 42.42, "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": 76.36, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 76.36, "10th_percentile": 76.36, "90th_percentile": 76.36, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 54.21, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 54.21, "10th_percentile": 54.21, "90th_percentile": 54.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 69.57, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 69.57, "10th_percentile": 69.57, "90th_percentile": 69.57, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 41.23, "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": 41.23, "10th_percentile": 41.23, "90th_percentile": 41.23, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 40.21, "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": 40.21, "10th_percentile": 40.21, "90th_percentile": 40.21, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 54.49, "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": 54.49, "10th_percentile": 54.49, "90th_percentile": 54.49, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 84.84, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 17.82, "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": 17.82, "10th_percentile": 17.82, "90th_percentile": 17.82, "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 HMO/PPO", "standard_charge_dollar": 44.71, "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": 44.71, "10th_percentile": 44.71, "90th_percentile": 44.71, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "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": 84.84, "10th_percentile": 84.84, "90th_percentile": 84.84, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ADPT SLV FEM C TAPR UNIV +5MM TI", "code_information": [ { "code": "SUP-123261", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 172.68, "maximum": 1040.26, "setting": "outpatient", "gross_charge": 1040.26, "discounted_cash": 728.18, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 172.68, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $1,040.26 @ 12.8% = $133.15 due to $0.00 Claim Price", "median_amount": 133.15, "10th_percentile": 133.15, "90th_percentile": 133.15, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,040.26 @ 12.8% = $133.15 due to $0.00 Claim Price" }, { "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": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "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": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "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": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "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": 832.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 832.21, "10th_percentile": 832.21, "90th_percentile": 832.21, "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": 832.21, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 832.21, "10th_percentile": 832.21, "90th_percentile": 832.21, "count": "0", "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": 220.43, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 220.43, "10th_percentile": 220.43, "90th_percentile": 220.43, "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": 220.43, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 220.43, "10th_percentile": 220.43, "90th_percentile": 220.43, "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": 283.99, "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": 283.99, "10th_percentile": 283.99, "90th_percentile": 283.99, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 283.99, "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": 283.99, "10th_percentile": 283.99, "90th_percentile": 283.99, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1040.26, "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 $1,040.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "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 $1,040.26 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": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1040.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1040.26, "10th_percentile": 1040.26, "90th_percentile": 1040.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 548.22, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 218.45, "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": 218.45, "10th_percentile": 218.45, "90th_percentile": 218.45, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 936.23, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 936.23, "10th_percentile": 936.23, "90th_percentile": 936.23, "count": "0", "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": 505.57, "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": 505.57, "10th_percentile": 505.57, "90th_percentile": 505.57, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 473.32, "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": 473.32, "10th_percentile": 473.32, "90th_percentile": 473.32, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 664.73, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 664.73, "10th_percentile": 664.73, "90th_percentile": 664.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 520.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 520.13, "10th_percentile": 520.13, "90th_percentile": 520.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 801.0, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 801.0, "10th_percentile": 801.0, "90th_percentile": 801.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 447.31, "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": 447.31, "10th_percentile": 447.31, "90th_percentile": 447.31, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 668.16, "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": 668.16, "10th_percentile": 668.16, "90th_percentile": 668.16, "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": 493.08, "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": 493.08, "10th_percentile": 493.08, "90th_percentile": 493.08, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 243.42, "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": 243.42, "10th_percentile": 243.42, "90th_percentile": 243.42, "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": 243.42, "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": 243.42, "10th_percentile": 243.42, "90th_percentile": 243.42, "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 SELECT", "standard_charge_dollar": 243.42, "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": 243.42, "10th_percentile": 243.42, "90th_percentile": 243.42, "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." } ] } ] }, { "description": "ADPT SLV FEM MRSE C TAPR", "code_information": [ { "code": "SUP-144617", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 169.65, "maximum": 1021.98, "setting": "outpatient", "gross_charge": 1021.98, "discounted_cash": 715.39, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 169.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $1,021.98 @ 12.8% = $130.81 due to $0.00 Claim Price", "median_amount": 130.81, "10th_percentile": 130.81, "90th_percentile": 130.81, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,021.98 @ 12.8% = $130.81 due to $0.00 Claim Price" }, { "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": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "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": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "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": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "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 PPO", "standard_charge_dollar": 279.0, "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": 279.0, "10th_percentile": 279.0, "90th_percentile": 279.0, "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": 279.0, "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": 279.0, "10th_percentile": 279.0, "90th_percentile": 279.0, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 817.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 817.58, "10th_percentile": 817.58, "90th_percentile": 817.58, "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": 817.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 817.58, "10th_percentile": 817.58, "90th_percentile": 817.58, "count": "0", "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": 216.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 216.56, "10th_percentile": 216.56, "90th_percentile": 216.56, "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": 216.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 216.56, "10th_percentile": 216.56, "90th_percentile": 216.56, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1021.98, "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 $1,021.98 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "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 $1,021.98 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1021.98, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 1021.98, "10th_percentile": 1021.98, "90th_percentile": 1021.98, "count": "0", "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": 538.58, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 484.42, "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": 484.42, "10th_percentile": 484.42, "90th_percentile": 484.42, "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": 786.92, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 786.92, "10th_percentile": 786.92, "90th_percentile": 786.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 214.62, "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": 214.62, "10th_percentile": 214.62, "90th_percentile": 214.62, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 919.78, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 919.78, "10th_percentile": 919.78, "90th_percentile": 919.78, "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": 465.0, "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": 465.0, "10th_percentile": 465.0, "90th_percentile": 465.0, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 656.42, "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": 656.42, "10th_percentile": 656.42, "90th_percentile": 656.42, "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 BROAD", "standard_charge_dollar": 496.68, "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": 496.68, "10th_percentile": 496.68, "90th_percentile": 496.68, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 653.05, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 653.05, "10th_percentile": 653.05, "90th_percentile": 653.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 510.99, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 510.99, "10th_percentile": 510.99, "90th_percentile": 510.99, "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", "standard_charge_dollar": 439.45, "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": 439.45, "10th_percentile": 439.45, "90th_percentile": 439.45, "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": 239.14, "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": 239.14, "10th_percentile": 239.14, "90th_percentile": 239.14, "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": 239.14, "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": 239.14, "10th_percentile": 239.14, "90th_percentile": 239.14, "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 SELECT", "standard_charge_dollar": 239.14, "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": 239.14, "10th_percentile": 239.14, "90th_percentile": 239.14, "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." } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 8077.88, "maximum": 16379.12, "setting": "inpatient", "gross_charge": 42791.14, "discounted_cash": 29953.8, "payers_information": [ { "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, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 42784.39, "10th_percentile": 42784.39, "90th_percentile": 42784.39, "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 anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 7102.21, "10th_percentile": 7102.21, "90th_percentile": 7102.21, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 16379.12, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63151.75, "10th_percentile": 63151.75, "90th_percentile": 63151.75, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 12463.67, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12463.67, "10th_percentile": 12463.67, "90th_percentile": 12463.67, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_dollar": 8077.88, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Transfer payment: $8,753.63; Total: $8,753.63 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8753.63, "10th_percentile": 8753.63, "90th_percentile": 8753.63, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Transfer payment: $8,753.63; Total: $8,753.63 Paid at contractual rate, which is the lesser 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_dollar": 8077.88, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Transfer payment: $9,749.37; Total: $9,749.37", "median_amount": 9749.37, "10th_percentile": 9749.37, "90th_percentile": 9749.37, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Transfer payment: $9,749.37; Total: $9,749.37" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_percentage": 85.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 36366.73, "10th_percentile": 36366.73, "90th_percentile": 36366.73, "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 anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 30804.76, "10th_percentile": 30804.76, "90th_percentile": 30804.76, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services - OON; 100% Billed", "median_amount": 42784.39, "10th_percentile": 42784.39, "90th_percentile": 42784.39, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 42784.39, "10th_percentile": 42784.39, "90th_percentile": 42784.39, "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.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; Inpatient Services; 50% Billed", "median_amount": 21392.2, "10th_percentile": 21392.2, "90th_percentile": 21392.2, "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.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; 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": 13006.45, "10th_percentile": 13006.45, "90th_percentile": 13006.45, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; IP Services; 65% Billed", "median_amount": 27809.85, "10th_percentile": 27809.85, "90th_percentile": 27809.85, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 14028.95, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 12,458.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE STOP LOSS & LESSOR OF 9*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14028.95, "10th_percentile": 14028.95, "90th_percentile": 14028.95, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 13373.56, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 11,876.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE PREF STOP LOSS & LESSOR*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13373.56, "10th_percentile": 13373.56, "90th_percentile": 13373.56, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 13111.18, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 11,643.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE SELECT STOP LOSS & LESS*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13111.18, "10th_percentile": 13111.18, "90th_percentile": 13111.18, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 16379.12, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 63151.75, "10th_percentile": 63151.75, "90th_percentile": 63151.75, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 12463.67, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1261, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12463.67, "10th_percentile": 12463.67, "90th_percentile": 12463.67, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 8077.88, "standard_charge_algorithm": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Transfer payment: $10,602.50; Total: $10,602.50", "median_amount": 10602.5, "10th_percentile": 10602.5, "90th_percentile": 10602.5, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.745177360; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.13, and; Pricing Extension - NM HB XR PRC - Medicare IP DRG Calculation; Note: Transfer payment: $10,602.50; Total: $10,602.50" } ] } ] }, { "description": "ALBUMIN, HUMAN 25 % IV SOLP", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-8981", "type": "CDM" }, { "code": "P9047", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00944-0493-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 101.76, "maximum": 613.0, "setting": "outpatient", "gross_charge": 613.0, "discounted_cash": 429.1, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 143.44, "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": 143.44, "10th_percentile": 143.44, "90th_percentile": 143.44, "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": 143.44, "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": 143.44, "10th_percentile": 143.44, "90th_percentile": 143.44, "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": 143.44, "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": 143.44, "10th_percentile": 143.44, "90th_percentile": 143.44, "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 HMO", "standard_charge_dollar": 129.89, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "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": 129.89, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 129.89, "10th_percentile": 129.89, "90th_percentile": 129.89, "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": 490.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 490.4, "10th_percentile": 490.4, "90th_percentile": 490.4, "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": 490.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 490.4, "10th_percentile": 490.4, "90th_percentile": 490.4, "count": "0", "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": 167.35, "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": 167.35, "10th_percentile": 167.35, "90th_percentile": 167.35, "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": 167.35, "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": 167.35, "10th_percentile": 167.35, "90th_percentile": 167.35, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 613.0, "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 $613.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 613.0, "10th_percentile": 613.0, "90th_percentile": 613.0, "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 $613.00 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 613.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 613.0, "10th_percentile": 613.0, "90th_percentile": 613.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 613.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 613.0, "10th_percentile": 613.0, "90th_percentile": 613.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 551.7, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 551.7, "10th_percentile": 551.7, "90th_percentile": 551.7, "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": 278.92, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 278.92, "10th_percentile": 278.92, "90th_percentile": 278.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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 NM EMPLOYEES", "standard_charge_dollar": 101.76, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 101.76, "10th_percentile": 101.76, "90th_percentile": 101.76, "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": 306.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 306.5, "10th_percentile": 306.5, "90th_percentile": 306.5, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 391.71, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 391.71, "10th_percentile": 391.71, "90th_percentile": 391.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 275.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 275.85, "10th_percentile": 275.85, "90th_percentile": 275.85, "count": "0", "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": 502.66, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 502.66, "10th_percentile": 502.66, "90th_percentile": 502.66, "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 $19,355 CASE RATE" }, { "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: $613.00 @ 12.8% = $78.46 due to $0.00 Claim Price", "median_amount": 78.46, "10th_percentile": 78.46, "90th_percentile": 78.46, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $613.00 @ 12.8% = $78.46 due to $0.00 Claim Price" }, { "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": 613.0, "10th_percentile": 613.0, "90th_percentile": 613.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 613.0, "10th_percentile": 613.0, "90th_percentile": 613.0, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 613.0, "10th_percentile": 613.0, "90th_percentile": 613.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 613.0, "10th_percentile": 613.0, "90th_percentile": 613.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG/0.5 ML INH NEBU", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-97580", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00487-9901-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.66, "maximum": 4.0, "setting": "outpatient", "gross_charge": 4.0, "discounted_cash": 2.8, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3.28, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 3.28, "10th_percentile": 3.28, "90th_percentile": 3.28, "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": 2.56, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2.56, "10th_percentile": 2.56, "90th_percentile": 2.56, "count": "0", "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": 3.6, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3.6, "10th_percentile": 3.6, "90th_percentile": 3.6, "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": 2.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "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": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3.2, "10th_percentile": 3.2, "90th_percentile": 3.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2.57, "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": 2.57, "10th_percentile": 2.57, "90th_percentile": 2.57, "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": 1.9, "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": 1.9, "10th_percentile": 1.9, "90th_percentile": 1.9, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2.11, "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": 2.11, "10th_percentile": 2.11, "90th_percentile": 2.11, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1.72, "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": 1.72, "10th_percentile": 1.72, "90th_percentile": 1.72, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1.82, "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": 1.82, "10th_percentile": 1.82, "90th_percentile": 1.82, "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 NM EMPLOYEES", "standard_charge_dollar": 0.66, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.66, "10th_percentile": 0.66, "90th_percentile": 0.66, "count": "0", "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": 0.85, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.85, "10th_percentile": 0.85, "90th_percentile": 0.85, "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": 1.09, "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": 1.09, "10th_percentile": 1.09, "90th_percentile": 1.09, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3.2, "10th_percentile": 3.2, "90th_percentile": 3.2, "count": "0", "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": 1.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1.8, "10th_percentile": 1.8, "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": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.93, "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": 0.93, "10th_percentile": 0.93, "90th_percentile": 0.93, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 0.88, "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": 0.88, "10th_percentile": 0.88, "90th_percentile": 0.88, "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": 0.84, "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": 0.84, "10th_percentile": 0.84, "90th_percentile": 0.84, "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 HMO", "standard_charge_dollar": 0.85, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.85, "10th_percentile": 0.85, "90th_percentile": 0.85, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 4.0, "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 $4.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4.0, "10th_percentile": 4.0, "90th_percentile": 4.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "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 $4.00 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": "NLFH BCBS PPO", "standard_charge_dollar": 1.09, "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": 1.09, "10th_percentile": 1.09, "90th_percentile": 1.09, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.84, "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": 0.84, "10th_percentile": 0.84, "90th_percentile": 0.84, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1.94, "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": 1.94, "10th_percentile": 1.94, "90th_percentile": 1.94, "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." } ] } ] }, { "description": "ALBUTEROL SULFATE 90 MCG/ACTUATION INH HFAA", "drug_information": { "unit": 8.5, "type": "GR" }, "code_information": [ { "code": "RX-17837", "type": "CDM" }, { "code": "CHRG1841", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "45802-0088-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 33.32, "maximum": 200.75, "setting": "outpatient", "gross_charge": 200.75, "discounted_cash": 140.52, "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": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "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": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "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": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "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": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "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 BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 200.75, "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 $200.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "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 $200.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 200.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 200.75, "10th_percentile": 200.75, "90th_percentile": 200.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 86.32, "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": 86.32, "10th_percentile": 86.32, "90th_percentile": 86.32, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 91.34, "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": 91.34, "10th_percentile": 91.34, "90th_percentile": 91.34, "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 NM EMPLOYEES", "standard_charge_dollar": 33.32, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 33.32, "10th_percentile": 33.32, "90th_percentile": 33.32, "count": "0", "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": 42.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 42.54, "10th_percentile": 42.54, "90th_percentile": 42.54, "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": 54.82, "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": 54.82, "10th_percentile": 54.82, "90th_percentile": 54.82, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 160.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 160.6, "10th_percentile": 160.6, "90th_percentile": 160.6, "count": "0", "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": 90.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 90.34, "10th_percentile": 90.34, "90th_percentile": 90.34, "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 OPTIONS", "standard_charge_dollar": 46.71, "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": 46.71, "10th_percentile": 46.71, "90th_percentile": 46.71, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 44.19, "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": 44.19, "10th_percentile": 44.19, "90th_percentile": 44.19, "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": 42.08, "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": 42.08, "10th_percentile": 42.08, "90th_percentile": 42.08, "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 HMO", "standard_charge_dollar": 42.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 42.54, "10th_percentile": 42.54, "90th_percentile": 42.54, "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": 54.82, "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": 54.82, "10th_percentile": 54.82, "90th_percentile": 54.82, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 42.16, "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": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 97.56, "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": 97.56, "10th_percentile": 97.56, "90th_percentile": 97.56, "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": 164.62, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 164.62, "10th_percentile": 164.62, "90th_percentile": 164.62, "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": 128.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 128.28, "10th_percentile": 128.28, "90th_percentile": 128.28, "count": "0", "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": 180.68, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 180.68, "10th_percentile": 180.68, "90th_percentile": 180.68, "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": 100.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 100.38, "10th_percentile": 100.38, "90th_percentile": 100.38, "count": "0", "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": 160.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 160.6, "10th_percentile": 160.6, "90th_percentile": 160.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 128.94, "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": 128.94, "10th_percentile": 128.94, "90th_percentile": 128.94, "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": 95.16, "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": 95.16, "10th_percentile": 95.16, "90th_percentile": 95.16, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 105.8, "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": 105.8, "10th_percentile": 105.8, "90th_percentile": 105.8, "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." } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 12062.66, "maximum": 24458.87, "setting": "inpatient", "gross_charge": 39595.24, "discounted_cash": 27716.67, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 24458.87, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.6816, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24458.87, "10th_percentile": 24458.87, "90th_percentile": 24458.87, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 18611.95, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.6816, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18611.95, "10th_percentile": 18611.95, "90th_percentile": 18611.95, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 24458.87, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.6816, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 24458.87, "10th_percentile": 24458.87, "90th_percentile": 24458.87, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 20949.37, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.6816, Rate: 12,458.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE STOP LOSS & LESSOR OF 9*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20949.37, "10th_percentile": 20949.37, "90th_percentile": 20949.37, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 19970.68, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.6816, Rate: 11,876.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE PREF STOP LOSS & LESSOR*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19970.68, "10th_percentile": 19970.68, "90th_percentile": 19970.68, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 19578.87, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.6816, Rate: 11,643.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE SELECT STOP LOSS & LESS*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 19578.87, "10th_percentile": 19578.87, "90th_percentile": 19578.87, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 18611.95, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.6816, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18611.95, "10th_percentile": 18611.95, "90th_percentile": 18611.95, "count": "1 through 10", "methodology": "case rate" }, { "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, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 39384.75, "10th_percentile": 39384.75, "90th_percentile": 39384.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 39384.75, "10th_percentile": 39384.75, "90th_percentile": 39384.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services - OON; 100% Billed", "median_amount": 39384.75, "10th_percentile": 39384.75, "90th_percentile": 39384.75, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; IP Services; 65% Billed", "median_amount": 25600.09, "10th_percentile": 25600.09, "90th_percentile": 25600.09, "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.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; Inpatient Services; 50% Billed", "median_amount": 19692.38, "10th_percentile": 19692.38, "90th_percentile": 19692.38, "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.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; 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": 11972.96, "10th_percentile": 11972.96, "90th_percentile": 11972.96, "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, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 6537.85, "10th_percentile": 6537.85, "90th_percentile": 6537.85, "count": "1 through 10", "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 drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 33477.04, "10th_percentile": 33477.04, "90th_percentile": 33477.04, "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, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 28357.02, "10th_percentile": 28357.02, "90th_percentile": 28357.02, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_dollar": 12062.66, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.68, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $14,140.85; Total: $14,140.85", "median_amount": 14140.85, "10th_percentile": 14140.85, "90th_percentile": 14140.85, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.68, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $14,140.85; Total: $14,140.85" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 12062.66, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.68, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $14,140.85; Total: $14,140.85", "median_amount": 14140.85, "10th_percentile": 14140.85, "90th_percentile": 14140.85, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.68, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $14,140.85; Total: $14,140.85" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_dollar": 12062.66, "standard_charge_algorithm": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.68, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $13,071.77; Total: $13,071.77 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13071.77, "10th_percentile": 13071.77, "90th_percentile": 13071.77, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.678346545; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.68, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $13,071.77; Total: $13,071.77 Paid at contractual rate, which is 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": "ALLOGRAFT TRIAD CC LORDOTIC 6X11X14MM", "code_information": [ { "code": "SUP-336922", "type": "CDM" }, { "code": "C1734", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 931.58, "maximum": 5611.9, "setting": "outpatient", "gross_charge": 5611.9, "discounted_cash": 3928.33, "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": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "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": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "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": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "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_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: $5,611.90 @ 12.8% = $718.32 due to $0.00 Claim Price", "median_amount": 718.32, "10th_percentile": 718.32, "90th_percentile": 718.32, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,611.90 @ 12.8% = $718.32 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2525.36, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2525.36, "10th_percentile": 2525.36, "90th_percentile": 2525.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1178.5, "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": 1178.5, "10th_percentile": 1178.5, "90th_percentile": 1178.5, "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": 2727.38, "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": 2727.38, "10th_percentile": 2727.38, "90th_percentile": 2727.38, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3604.52, "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": 3604.52, "10th_percentile": 3604.52, "90th_percentile": 3604.52, "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": 4321.16, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4321.16, "10th_percentile": 4321.16, "90th_percentile": 4321.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3586.0, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3586.0, "10th_percentile": 3586.0, "90th_percentile": 3586.0, "count": "0", "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": 5050.71, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5050.71, "10th_percentile": 5050.71, "90th_percentile": 5050.71, "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": 2805.95, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2805.95, "10th_percentile": 2805.95, "90th_percentile": 2805.95, "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": 2957.47, "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": 2957.47, "10th_percentile": 2957.47, "90th_percentile": 2957.47, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2660.04, "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": 2660.04, "10th_percentile": 2660.04, "90th_percentile": 2660.04, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2553.41, "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": 2553.41, "10th_percentile": 2553.41, "90th_percentile": 2553.41, "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": 2413.12, "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": 2413.12, "10th_percentile": 2413.12, "90th_percentile": 2413.12, "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": 931.58, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 931.58, "10th_percentile": 931.58, "90th_percentile": 931.58, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 5611.9, "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 $5,611.90 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "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 $5,611.90 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5611.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4489.52, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4489.52, "10th_percentile": 4489.52, "90th_percentile": 4489.52, "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": 4489.52, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4489.52, "10th_percentile": 4489.52, "90th_percentile": 4489.52, "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": 1532.05, "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": 1532.05, "10th_percentile": 1532.05, "90th_percentile": 1532.05, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1532.05, "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": 1532.05, "10th_percentile": 1532.05, "90th_percentile": 1532.05, "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 HMO", "standard_charge_dollar": 1189.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1189.16, "10th_percentile": 1189.16, "90th_percentile": 1189.16, "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 HMO", "standard_charge_dollar": 1189.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1189.16, "10th_percentile": 1189.16, "90th_percentile": 1189.16, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 1313.18, "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": 1313.18, "10th_percentile": 1313.18, "90th_percentile": 1313.18, "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 SELECT", "standard_charge_dollar": 1313.18, "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": 1313.18, "10th_percentile": 1313.18, "90th_percentile": 1313.18, "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": 1313.18, "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": 1313.18, "10th_percentile": 1313.18, "90th_percentile": 1313.18, "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." } ] } ] }, { "description": "AMANTADINE HCL 50 MG/5 ML ORAL SOLN", "drug_information": { "unit": 473.0, "type": "ML" }, "code_information": [ { "code": "RX-365", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00121-0646-16", "type": "NDC" } ], "standard_charges": [ { "minimum": 29.13, "maximum": 175.5, "setting": "outpatient", "gross_charge": 175.5, "discounted_cash": 122.85, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "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": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "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": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "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": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "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": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "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 BCBS PPO", "standard_charge_dollar": 47.93, "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": 47.93, "10th_percentile": 47.93, "90th_percentile": 47.93, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 47.93, "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": 47.93, "10th_percentile": 47.93, "90th_percentile": 47.93, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 140.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 140.4, "10th_percentile": 140.4, "90th_percentile": 140.4, "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": 140.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 140.4, "10th_percentile": 140.4, "90th_percentile": 140.4, "count": "0", "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": 37.19, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 37.19, "10th_percentile": 37.19, "90th_percentile": 37.19, "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": 37.19, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 37.19, "10th_percentile": 37.19, "90th_percentile": 37.19, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 175.5, "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 $175.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "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 $175.50 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 SELECT", "standard_charge_dollar": 36.78, "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": 36.78, "10th_percentile": 36.78, "90th_percentile": 36.78, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 38.63, "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": 38.63, "10th_percentile": 38.63, "90th_percentile": 38.63, "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": 40.84, "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": 40.84, "10th_percentile": 40.84, "90th_percentile": 40.84, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 78.98, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 78.98, "10th_percentile": 78.98, "90th_percentile": 78.98, "count": "0", "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": 75.47, "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": 75.47, "10th_percentile": 75.47, "90th_percentile": 75.47, "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": 36.86, "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": 36.86, "10th_percentile": 36.86, "90th_percentile": 36.86, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 87.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 87.75, "10th_percentile": 87.75, "90th_percentile": 87.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 143.91, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 143.91, "10th_percentile": 143.91, "90th_percentile": 143.91, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 85.29, "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": 85.29, "10th_percentile": 85.29, "90th_percentile": 85.29, "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": 157.95, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 157.95, "10th_percentile": 157.95, "90th_percentile": 157.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 83.19, "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": 83.19, "10th_percentile": 83.19, "90th_percentile": 83.19, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 112.14, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 112.14, "10th_percentile": 112.14, "90th_percentile": 112.14, "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": 79.85, "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": 79.85, "10th_percentile": 79.85, "90th_percentile": 79.85, "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 NM EMPLOYEES", "standard_charge_dollar": 29.13, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 29.13, "10th_percentile": 29.13, "90th_percentile": 29.13, "count": "0", "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": 112.72, "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": 112.72, "10th_percentile": 112.72, "90th_percentile": 112.72, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 175.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 92.49, "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": 92.49, "10th_percentile": 92.49, "90th_percentile": 92.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 175.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 175.5, "10th_percentile": 175.5, "90th_percentile": 175.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "AMIKACIN 1000 MG/4 ML INJ SOLN", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "RX-183758", "type": "CDM" }, { "code": "J0278", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0815-22", "type": "NDC" } ], "standard_charges": [ { "minimum": 29.88, "maximum": 180.0, "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 126.0, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 42.12, "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": 42.12, "10th_percentile": 42.12, "90th_percentile": 42.12, "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 SELECT", "standard_charge_dollar": 42.12, "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": 42.12, "10th_percentile": 42.12, "90th_percentile": 42.12, "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": 42.12, "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": 42.12, "10th_percentile": 42.12, "90th_percentile": 42.12, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 38.14, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 38.14, "10th_percentile": 38.14, "90th_percentile": 38.14, "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 HMO", "standard_charge_dollar": 38.14, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 38.14, "10th_percentile": 38.14, "90th_percentile": 38.14, "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": 144.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 144.0, "10th_percentile": 144.0, "90th_percentile": 144.0, "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": 144.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 144.0, "10th_percentile": 144.0, "90th_percentile": 144.0, "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": 49.14, "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": 49.14, "10th_percentile": 49.14, "90th_percentile": 49.14, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 49.14, "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": 49.14, "10th_percentile": 49.14, "90th_percentile": 49.14, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 180.0, "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 $180.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "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 $180.00 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 180.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 180.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 115.02, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 115.02, "10th_percentile": 115.02, "90th_percentile": 115.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 90.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 162.0, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 162.0, "10th_percentile": 162.0, "90th_percentile": 162.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 29.88, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 29.88, "10th_percentile": 29.88, "90th_percentile": 29.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 81.9, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 81.9, "10th_percentile": 81.9, "90th_percentile": 81.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 81.0, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 81.0, "10th_percentile": 81.0, "90th_percentile": 81.0, "count": "0", "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": 147.6, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 147.6, "10th_percentile": 147.6, "90th_percentile": 147.6, "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 $19,355 CASE RATE" }, { "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: $180.00 @ 12.8% = $23.04 due to $0.00 Claim Price", "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 23.04, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $180.00 @ 12.8% = $23.04 due to $0.00 Claim Price" }, { "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": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMINOCAPROIC ACID 1000 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-98031", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "69680-0116-30", "type": "NDC" } ], "standard_charges": [ { "minimum": 14.48, "maximum": 87.25, "setting": "outpatient", "gross_charge": 87.25, "discounted_cash": 61.07, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "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": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "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": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "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": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 23.83, "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": 23.83, "10th_percentile": 23.83, "90th_percentile": 23.83, "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 PPO", "standard_charge_dollar": 23.83, "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": 23.83, "10th_percentile": 23.83, "90th_percentile": 23.83, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 18.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 18.49, "10th_percentile": 18.49, "90th_percentile": 18.49, "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 HMO", "standard_charge_dollar": 18.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 18.49, "10th_percentile": 18.49, "90th_percentile": 18.49, "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": 69.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 69.8, "10th_percentile": 69.8, "90th_percentile": 69.8, "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": 69.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 69.8, "10th_percentile": 69.8, "90th_percentile": 69.8, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 87.25, "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 $87.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "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 $87.25 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": 39.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 39.26, "10th_percentile": 39.26, "90th_percentile": 39.26, "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": 18.29, "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": 18.29, "10th_percentile": 18.29, "90th_percentile": 18.29, "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 PREFERRED", "standard_charge_dollar": 19.2, "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": 19.2, "10th_percentile": 19.2, "90th_percentile": 19.2, "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": 20.3, "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": 20.3, "10th_percentile": 20.3, "90th_percentile": 20.3, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 14.48, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 14.48, "10th_percentile": 14.48, "90th_percentile": 14.48, "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 ALTERNATIVE", "standard_charge_dollar": 18.32, "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": 18.32, "10th_percentile": 18.32, "90th_percentile": 18.32, "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 ASA", "standard_charge_dollar": 39.7, "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": 39.7, "10th_percentile": 39.7, "90th_percentile": 39.7, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 71.55, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 71.55, "10th_percentile": 71.55, "90th_percentile": 71.55, "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", "standard_charge_dollar": 37.52, "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": 37.52, "10th_percentile": 37.52, "90th_percentile": 37.52, "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": 43.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 43.63, "10th_percentile": 43.63, "90th_percentile": 43.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 87.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 42.4, "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": 42.4, "10th_percentile": 42.4, "90th_percentile": 42.4, "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": 78.53, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 78.53, "10th_percentile": 78.53, "90th_percentile": 78.53, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 55.75, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 55.75, "10th_percentile": 55.75, "90th_percentile": 55.75, "count": "0", "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": 45.98, "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": 45.98, "10th_percentile": 45.98, "90th_percentile": 45.98, "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": 56.04, "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": 56.04, "10th_percentile": 56.04, "90th_percentile": 56.04, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 87.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 87.25, "10th_percentile": 87.25, "90th_percentile": 87.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 41.36, "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": 41.36, "10th_percentile": 41.36, "90th_percentile": 41.36, "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." } ] } ] }, { "description": "AMINOPHYLLINE 500 MG/20 ML IV SOLN", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "RX-93458", "type": "CDM" }, { "code": "J0280", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00409-5922-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 15.27, "maximum": 92.0, "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 64.4, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 21.53, "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": 21.53, "10th_percentile": 21.53, "90th_percentile": 21.53, "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": 21.53, "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": 21.53, "10th_percentile": 21.53, "90th_percentile": 21.53, "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 SELECT", "standard_charge_dollar": 21.53, "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": 21.53, "10th_percentile": 21.53, "90th_percentile": 21.53, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 73.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 73.6, "10th_percentile": 73.6, "90th_percentile": 73.6, "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": 73.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 73.6, "10th_percentile": 73.6, "90th_percentile": 73.6, "count": "0", "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": 19.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "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": 19.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 19.49, "10th_percentile": 19.49, "90th_percentile": 19.49, "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": 25.12, "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": 25.12, "10th_percentile": 25.12, "90th_percentile": 25.12, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 25.12, "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": 25.12, "10th_percentile": 25.12, "90th_percentile": 25.12, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 92.0, "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 $92.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 92.0, "10th_percentile": 92.0, "90th_percentile": 92.0, "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 $92.00 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 92.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 92.0, "10th_percentile": 92.0, "90th_percentile": 92.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 92.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 92.0, "10th_percentile": 92.0, "90th_percentile": 92.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 82.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 82.8, "10th_percentile": 82.8, "90th_percentile": 82.8, "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": 46.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 46.0, "10th_percentile": 46.0, "90th_percentile": 46.0, "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 ASA", "standard_charge_dollar": 41.86, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 41.86, "10th_percentile": 41.86, "90th_percentile": 41.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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 PLATINUM/CHC ELITE", "standard_charge_dollar": 58.79, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 58.79, "10th_percentile": 58.79, "90th_percentile": 58.79, "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 NM EMPLOYEES", "standard_charge_dollar": 15.27, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 15.27, "10th_percentile": 15.27, "90th_percentile": 15.27, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 41.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 41.4, "10th_percentile": 41.4, "90th_percentile": 41.4, "count": "0", "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": 75.44, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP; 82% Billed", "median_amount": 75.44, "10th_percentile": 75.44, "90th_percentile": 75.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 82% 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: $92.00 @ 12.8% = $11.78 due to $0.00 Claim Price", "median_amount": 11.78, "10th_percentile": 11.78, "90th_percentile": 11.78, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $92.00 @ 12.8% = $11.78 due to $0.00 Claim Price" }, { "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": 92.0, "10th_percentile": 92.0, "90th_percentile": 92.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 92.0, "10th_percentile": 92.0, "90th_percentile": 92.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 92.0, "10th_percentile": 92.0, "90th_percentile": 92.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 92.0, "10th_percentile": 92.0, "90th_percentile": 92.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMIODARONE 50 MG/ML IV SOLN", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "RX-9065", "type": "CDM" }, { "code": "J0282", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0616-03", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.08, "maximum": 12.5, "setting": "outpatient", "gross_charge": 12.5, "discounted_cash": 8.75, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.93, "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": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "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 SELECT", "standard_charge_dollar": 2.93, "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": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "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": 2.93, "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": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "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 HMO", "standard_charge_dollar": 2.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.65, "10th_percentile": 2.65, "90th_percentile": 2.65, "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": 10.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10.0, "10th_percentile": 10.0, "90th_percentile": 10.0, "count": "0", "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": 3.41, "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": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 12.5, "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 $12.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "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 $12.50 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 12.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 12.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 7.99, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 7.99, "10th_percentile": 7.99, "90th_percentile": 7.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 6.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "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": 11.25, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 11.25, "10th_percentile": 11.25, "90th_percentile": 11.25, "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": 10.25, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 10.25, "10th_percentile": 10.25, "90th_percentile": 10.25, "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 $19,355 CASE RATE" }, { "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: $12.50 @ 12.8% = $1.60 due to $0.00 Claim Price", "median_amount": 1.6, "10th_percentile": 1.6, "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: $12.50 @ 12.8% = $1.60 due to $0.00 Claim Price" }, { "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": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2.65, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.65, "10th_percentile": 2.65, "90th_percentile": 2.65, "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": 10.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10.0, "10th_percentile": 10.0, "90th_percentile": 10.0, "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": 3.41, "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": 3.41, "10th_percentile": 3.41, "90th_percentile": 3.41, "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 ASA", "standard_charge_dollar": 5.69, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 5.69, "10th_percentile": 5.69, "90th_percentile": 5.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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 NM EMPLOYEES", "standard_charge_dollar": 2.08, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2.08, "10th_percentile": 2.08, "90th_percentile": 2.08, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 5.63, "10th_percentile": 5.63, "90th_percentile": 5.63, "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 ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "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": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMIODARONE IN DEXTROSE,ISO-OSM 150 MG/100 ML (1.5 MG/ML) IV SOLN", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-191197", "type": "CDM" }, { "code": "J0283", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "43066-0150-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 32.08, "maximum": 193.25, "setting": "outpatient", "gross_charge": 193.25, "discounted_cash": 135.27, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 45.22, "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": 45.22, "10th_percentile": 45.22, "90th_percentile": 45.22, "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": 45.22, "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": 45.22, "10th_percentile": 45.22, "90th_percentile": 45.22, "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 SELECT", "standard_charge_dollar": 45.22, "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": 45.22, "10th_percentile": 45.22, "90th_percentile": 45.22, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 154.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 154.6, "10th_percentile": 154.6, "90th_percentile": 154.6, "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": 154.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 154.6, "10th_percentile": 154.6, "90th_percentile": 154.6, "count": "0", "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": 40.95, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 40.95, "10th_percentile": 40.95, "90th_percentile": 40.95, "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": 40.95, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 40.95, "10th_percentile": 40.95, "90th_percentile": 40.95, "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": 52.76, "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": 52.76, "10th_percentile": 52.76, "90th_percentile": 52.76, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 52.76, "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": 52.76, "10th_percentile": 52.76, "90th_percentile": 52.76, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 193.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "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": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 193.25, "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 $193.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "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 $193.25 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 193.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 193.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 173.93, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 173.93, "10th_percentile": 173.93, "90th_percentile": 173.93, "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": 96.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 96.63, "10th_percentile": 96.63, "90th_percentile": 96.63, "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 ASA", "standard_charge_dollar": 87.93, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 87.93, "10th_percentile": 87.93, "90th_percentile": 87.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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 PLATINUM/CHC ELITE", "standard_charge_dollar": 123.49, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 123.49, "10th_percentile": 123.49, "90th_percentile": 123.49, "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 NM EMPLOYEES", "standard_charge_dollar": 32.08, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 32.08, "10th_percentile": 32.08, "90th_percentile": 32.08, "count": "0", "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": 158.47, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 158.47, "10th_percentile": 158.47, "90th_percentile": 158.47, "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 $19,355 CASE RATE" }, { "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: $193.25 @ 12.8% = $24.74 due to $0.00 Claim Price", "median_amount": 24.74, "10th_percentile": 24.74, "90th_percentile": 24.74, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $193.25 @ 12.8% = $24.74 due to $0.00 Claim Price" }, { "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": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "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": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "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": 193.25, "10th_percentile": 193.25, "90th_percentile": 193.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMITRIPTYLINE 10 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-432", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "50268-0037-15", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.54, "maximum": 3.25, "setting": "outpatient", "gross_charge": 3.25, "discounted_cash": 2.27, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "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": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "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": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "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": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "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": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "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 BCBS HMO", "standard_charge_dollar": 0.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.69, "10th_percentile": 0.69, "90th_percentile": 0.69, "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": 0.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.69, "10th_percentile": 0.69, "90th_percentile": 0.69, "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": 2.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "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": 2.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.6, "10th_percentile": 2.6, "90th_percentile": 2.6, "count": "0", "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": 0.89, "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": 0.89, "10th_percentile": 0.89, "90th_percentile": 0.89, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.89, "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": 0.89, "10th_percentile": 0.89, "90th_percentile": 0.89, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3.25, "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 $3.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "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 $3.25 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.72, "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": 0.72, "10th_percentile": 0.72, "90th_percentile": 0.72, "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 SELECT", "standard_charge_dollar": 0.68, "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": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "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 OPTIONS", "standard_charge_dollar": 0.76, "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": 0.76, "10th_percentile": 0.76, "90th_percentile": 0.76, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1.71, "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": 1.71, "10th_percentile": 1.71, "90th_percentile": 1.71, "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": 2.09, "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": 2.09, "10th_percentile": 2.09, "90th_percentile": 2.09, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.54, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2.08, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2.08, "10th_percentile": 2.08, "90th_percentile": 2.08, "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": 1.4, "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": 1.4, "10th_percentile": 1.4, "90th_percentile": 1.4, "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 BROAD", "standard_charge_dollar": 1.58, "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": 1.58, "10th_percentile": 1.58, "90th_percentile": 1.58, "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": 2.93, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.93, "10th_percentile": 2.93, "90th_percentile": 2.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.63, "10th_percentile": 1.63, "90th_percentile": 1.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2.67, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2.67, "10th_percentile": 2.67, "90th_percentile": 2.67, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1.48, "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": 1.48, "10th_percentile": 1.48, "90th_percentile": 1.48, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1.54, "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": 1.54, "10th_percentile": 1.54, "90th_percentile": 1.54, "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": 0.68, "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": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.25, "10th_percentile": 3.25, "90th_percentile": 3.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "AMIVANTAMAB-HYALURONIDASE-LPUJ 2,240 MG-28,000 UNIT/14 ML SUBQ SOLN", "drug_information": { "unit": 14.0, "type": "ML" }, "code_information": [ { "code": "RX-252461", "type": "CDM" }, { "code": "C9399", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "57894-0514-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 23993.64, "maximum": 144540.0, "setting": "outpatient", "gross_charge": 144540.0, "discounted_cash": 101178.0, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 30628.03, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 30628.03, "10th_percentile": 30628.03, "90th_percentile": 30628.03, "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": 39459.42, "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": 39459.42, "10th_percentile": 39459.42, "90th_percentile": 39459.42, "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": 23993.64, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 23993.64, "10th_percentile": 23993.64, "90th_percentile": 23993.64, "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 ASA", "standard_charge_dollar": 65765.7, "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": 65765.7, "10th_percentile": 65765.7, "90th_percentile": 65765.7, "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": 62152.2, "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": 62152.2, "10th_percentile": 62152.2, "90th_percentile": 62152.2, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 103346.1, "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Stop Loss; 71.5% Billed", "median_amount": 103346.1, "10th_percentile": 103346.1, "90th_percentile": 103346.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Stop Loss; 71.5% Billed" }, { "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": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 33822.36, "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": 33822.36, "10th_percentile": 33822.36, "90th_percentile": 33822.36, "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": 33822.36, "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": 33822.36, "10th_percentile": 33822.36, "90th_percentile": 33822.36, "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": 33822.36, "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": 33822.36, "10th_percentile": 33822.36, "90th_percentile": 33822.36, "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 HMO", "standard_charge_dollar": 30628.03, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 30628.03, "10th_percentile": 30628.03, "90th_percentile": 30628.03, "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": 39459.42, "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": 39459.42, "10th_percentile": 39459.42, "90th_percentile": 39459.42, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 144540.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 144540.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "OP C9399 - Unclassified for Review; 100% Billed", "median_amount": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP C9399 - Unclassified for Review; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 144540.0, "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 $144,540.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "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 $144,540.00 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 144540.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 144540.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 130086.0, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 130086.0, "10th_percentile": 130086.0, "90th_percentile": 130086.0, "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": 72270.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 72270.0, "10th_percentile": 72270.0, "90th_percentile": 72270.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 92361.06, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 92361.06, "10th_percentile": 92361.06, "90th_percentile": 92361.06, "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": 92838.04, "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": 92838.04, "10th_percentile": 92838.04, "90th_percentile": 92838.04, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 103346.1, "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Stop Loss; 71.5% Billed", "median_amount": 103346.1, "10th_percentile": 103346.1, "90th_percentile": 103346.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Stop Loss; 71.5% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 118522.8, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE; Note: Expected reimbursement cap of $19355 reached.", "median_amount": 19355.0, "10th_percentile": 19355.0, "90th_percentile": 19355.0, "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 $19,355 CASE RATE; Note: Expected reimbursement cap of $19355 reached." }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 72270.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "High Cost Drugs Default; 50% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 72270.0, "10th_percentile": 72270.0, "90th_percentile": 72270.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs Default; 50% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of 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": 72270.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "High Cost Drugs Default; 50% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 72270.0, "10th_percentile": 72270.0, "90th_percentile": 72270.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "High Cost Drugs Default; 50% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser 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": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 144540.0, "10th_percentile": 144540.0, "90th_percentile": 144540.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "RX-33230", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00143-9982-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 18.76, "maximum": 113.0, "setting": "outpatient", "gross_charge": 113.0, "discounted_cash": 79.1, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "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": "NLFH BCBS PPO", "standard_charge_dollar": 30.86, "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": 30.86, "10th_percentile": 30.86, "90th_percentile": 30.86, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 30.86, "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": 30.86, "10th_percentile": 30.86, "90th_percentile": 30.86, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 90.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 90.4, "10th_percentile": 90.4, "90th_percentile": 90.4, "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": 90.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 90.4, "10th_percentile": 90.4, "90th_percentile": 90.4, "count": "0", "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": 23.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 23.94, "10th_percentile": 23.94, "90th_percentile": 23.94, "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": 23.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 23.94, "10th_percentile": 23.94, "90th_percentile": 23.94, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 113.0, "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 $113.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "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 $113.00 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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 23.68, "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": 23.68, "10th_percentile": 23.68, "90th_percentile": 23.68, "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 PREFERRED", "standard_charge_dollar": 24.87, "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": 24.87, "10th_percentile": 24.87, "90th_percentile": 24.87, "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": 26.3, "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": 26.3, "10th_percentile": 26.3, "90th_percentile": 26.3, "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": 50.85, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 50.85, "10th_percentile": 50.85, "90th_percentile": 50.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 23.73, "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": 23.73, "10th_percentile": 23.73, "90th_percentile": 23.73, "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 NM EMPLOYEES", "standard_charge_dollar": 18.76, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 18.76, "10th_percentile": 18.76, "90th_percentile": 18.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 72.21, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 72.21, "10th_percentile": 72.21, "90th_percentile": 72.21, "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": 48.59, "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": 48.59, "10th_percentile": 48.59, "90th_percentile": 48.59, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 113.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 56.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 56.5, "10th_percentile": 56.5, "90th_percentile": 56.5, "count": "0", "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": 72.58, "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": 72.58, "10th_percentile": 72.58, "90th_percentile": 72.58, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 101.7, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 101.7, "10th_percentile": 101.7, "90th_percentile": 101.7, "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": 51.42, "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": 51.42, "10th_percentile": 51.42, "90th_percentile": 51.42, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 113.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 113.0, "10th_percentile": 113.0, "90th_percentile": 113.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 53.56, "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": 53.56, "10th_percentile": 53.56, "90th_percentile": 53.56, "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 BROAD", "standard_charge_dollar": 54.92, "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": 54.92, "10th_percentile": 54.92, "90th_percentile": 54.92, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 59.55, "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": 59.55, "10th_percentile": 59.55, "90th_percentile": 59.55, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 92.66, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 92.66, "10th_percentile": 92.66, "90th_percentile": 92.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; All Other OP; 82% 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": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "65862-0502-20", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.5, "maximum": 3.0, "setting": "outpatient", "gross_charge": 3.0, "discounted_cash": 2.1, "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": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.64, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.64, "10th_percentile": 0.64, "90th_percentile": 0.64, "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": 0.5, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.5, "10th_percentile": 0.5, "90th_percentile": 0.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1.29, "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": 1.29, "10th_percentile": 1.29, "90th_percentile": 1.29, "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 ASA", "standard_charge_dollar": 1.37, "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": 1.37, "10th_percentile": 1.37, "90th_percentile": 1.37, "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": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.82, "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": 0.82, "10th_percentile": 0.82, "90th_percentile": 0.82, "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 PPO", "standard_charge_dollar": 0.82, "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": 0.82, "10th_percentile": 0.82, "90th_percentile": 0.82, "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 HMO", "standard_charge_dollar": 0.64, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.64, "10th_percentile": 0.64, "90th_percentile": 0.64, "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": 2.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "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": 2.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.4, "10th_percentile": 2.4, "90th_percentile": 2.4, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3.0, "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 $3.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "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 $3.00 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": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1.35, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1.35, "10th_percentile": 1.35, "90th_percentile": 1.35, "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": 0.63, "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": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "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 PREFERRED", "standard_charge_dollar": 0.66, "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": 0.66, "10th_percentile": 0.66, "90th_percentile": 0.66, "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": 0.7, "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": 0.7, "10th_percentile": 0.7, "90th_percentile": 0.7, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.63, "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": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "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": 2.46, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "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": 1.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.5, "10th_percentile": 1.5, "90th_percentile": 1.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1.46, "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": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3.0, "10th_percentile": 3.0, "90th_percentile": 3.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2.7, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1.58, "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": 1.58, "10th_percentile": 1.58, "90th_percentile": 1.58, "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": 1.93, "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": 1.93, "10th_percentile": 1.93, "90th_percentile": 1.93, "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": 1.42, "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": 1.42, "10th_percentile": 1.42, "90th_percentile": 1.42, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 1.92, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1.92, "10th_percentile": 1.92, "90th_percentile": 1.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" } ] } ] }, { "description": "AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR", "drug_information": { "unit": 75.0, "type": "ML" }, "code_information": [ { "code": "RX-31177", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "00781-6139-57", "type": "NDC" } ], "standard_charges": [ { "minimum": 12.41, "maximum": 74.75, "setting": "outpatient", "gross_charge": 74.75, "discounted_cash": 52.32, "payers_information": [ { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "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": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "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": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "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": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "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": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "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 BCBS PPO", "standard_charge_dollar": 20.41, "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": 20.41, "10th_percentile": 20.41, "90th_percentile": 20.41, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 20.41, "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": 20.41, "10th_percentile": 20.41, "90th_percentile": 20.41, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 59.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 59.8, "10th_percentile": 59.8, "90th_percentile": 59.8, "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": 59.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 59.8, "10th_percentile": 59.8, "90th_percentile": 59.8, "count": "0", "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": 15.84, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 15.84, "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": 15.84, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 15.84, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 74.75, "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 $74.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "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 $74.75 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 BCBS BLUECHOICE SELECT", "standard_charge_dollar": 15.67, "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": 15.67, "10th_percentile": 15.67, "90th_percentile": 15.67, "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 PREFERRED", "standard_charge_dollar": 16.45, "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": 16.45, "10th_percentile": 16.45, "90th_percentile": 16.45, "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": 17.39, "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": 17.39, "10th_percentile": 17.39, "90th_percentile": 17.39, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 33.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 33.64, "10th_percentile": 33.64, "90th_percentile": 33.64, "count": "0", "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": 32.14, "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": 32.14, "10th_percentile": 32.14, "90th_percentile": 32.14, "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": 15.7, "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": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 37.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 37.38, "10th_percentile": 37.38, "90th_percentile": 37.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 61.3, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 61.3, "10th_percentile": 61.3, "90th_percentile": 61.3, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 36.33, "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": 36.33, "10th_percentile": 36.33, "90th_percentile": 36.33, "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": 67.28, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 67.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 35.43, "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": 35.43, "10th_percentile": 35.43, "90th_percentile": 35.43, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 47.77, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 47.77, "10th_percentile": 47.77, "90th_percentile": 47.77, "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": 34.01, "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": 34.01, "10th_percentile": 34.01, "90th_percentile": 34.01, "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 NM EMPLOYEES", "standard_charge_dollar": 12.41, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 12.41, "10th_percentile": 12.41, "90th_percentile": 12.41, "count": "0", "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": 48.01, "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": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 74.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 39.39, "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": 39.39, "10th_percentile": 39.39, "90th_percentile": 39.39, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 74.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 74.75, "10th_percentile": 74.75, "90th_percentile": 74.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-33228", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "60687-0803-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 2.45, "maximum": 14.75, "setting": "outpatient", "gross_charge": 14.75, "discounted_cash": 10.32, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3.45, "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": 3.45, "10th_percentile": 3.45, "90th_percentile": 3.45, "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": 3.45, "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": 3.45, "10th_percentile": 3.45, "90th_percentile": 3.45, "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 SELECT", "standard_charge_dollar": 3.45, "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": 3.45, "10th_percentile": 3.45, "90th_percentile": 3.45, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 6.34, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "Drugs/Agents Default; 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": 6.34, "10th_percentile": 6.34, "90th_percentile": 6.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 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": 6.71, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 6.71, "10th_percentile": 6.71, "90th_percentile": 6.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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 NM EMPLOYEES", "standard_charge_dollar": 2.45, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "count": "0", "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": 3.13, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.13, "10th_percentile": 3.13, "90th_percentile": 3.13, "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": 4.03, "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": 4.03, "10th_percentile": 4.03, "90th_percentile": 4.03, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 11.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11.8, "10th_percentile": 11.8, "90th_percentile": 11.8, "count": "0", "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": 6.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 6.64, "10th_percentile": 6.64, "90th_percentile": 6.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 3.13, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.13, "10th_percentile": 3.13, "90th_percentile": 3.13, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 14.75, "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 $14.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $14.75 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 BCBS PPO", "standard_charge_dollar": 4.03, "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": 4.03, "10th_percentile": 4.03, "90th_percentile": 4.03, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 12.1, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 12.1, "10th_percentile": 12.1, "90th_percentile": 12.1, "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 $19,355 CASE RATE" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 9.43, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 9.43, "10th_percentile": 9.43, "90th_percentile": 9.43, "count": "0", "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": 13.28, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 13.28, "10th_percentile": 13.28, "90th_percentile": 13.28, "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": 7.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 7.38, "10th_percentile": 7.38, "90th_percentile": 7.38, "count": "0", "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": 11.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11.8, "10th_percentile": 11.8, "90th_percentile": 11.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 9.47, "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": 9.47, "10th_percentile": 9.47, "90th_percentile": 9.47, "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": 6.99, "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": 6.99, "10th_percentile": 6.99, "90th_percentile": 6.99, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 7.77, "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": 7.77, "10th_percentile": 7.77, "90th_percentile": 7.77, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "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: $14.75 @ 12.8% = $1.89 due to $0.00 Claim Price", "median_amount": 1.89, "10th_percentile": 1.89, "90th_percentile": 1.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14.75 @ 12.8% = $1.89 due to $0.00 Claim Price" }, { "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": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14.75, "10th_percentile": 14.75, "90th_percentile": 14.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AMPLATZ GUIDEWIRE ULTRA STIFF PTFE FXD CORE 35 INX145CM G53566", "code_information": [ { "code": "SUP-359274", "type": "CDM" }, { "code": "C1769", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 43.55, "maximum": 262.36, "setting": "outpatient", "gross_charge": 262.36, "discounted_cash": 183.65, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 138.26, "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": 138.79, "10th_percentile": 138.79, "90th_percentile": 138.79, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 127.51, "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": 478.76, "10th_percentile": 478.76, "90th_percentile": 478.76, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 262.36, "10th_percentile": 262.36, "90th_percentile": 262.36, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 262.36, "10th_percentile": 262.36, "90th_percentile": 262.36, "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": 262.36, "10th_percentile": 262.36, "90th_percentile": 262.36, "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": 262.36, "10th_percentile": 262.36, "90th_percentile": 262.36, "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_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: $262.36 @ 12.8% = $33.58 due to $0.00 Claim Price", "median_amount": 33.58, "10th_percentile": 33.58, "90th_percentile": 33.58, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $262.36 @ 12.8% = $33.58 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 61.39, "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": 61.39, "10th_percentile": 61.39, "90th_percentile": 61.39, "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 SELECT", "standard_charge_dollar": 61.39, "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": 61.39, "10th_percentile": 61.39, "90th_percentile": 61.39, "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": 61.39, "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": 61.39, "10th_percentile": 61.39, "90th_percentile": 61.39, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 71.62, "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": 71.62, "10th_percentile": 71.62, "90th_percentile": 71.62, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 71.62, "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": 71.62, "10th_percentile": 71.62, "90th_percentile": 71.62, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 209.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 209.89, "10th_percentile": 209.89, "90th_percentile": 209.89, "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": 209.89, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 209.89, "10th_percentile": 209.89, "90th_percentile": 209.89, "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": 55.59, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 55.59, "10th_percentile": 55.59, "90th_percentile": 55.59, "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 HMO", "standard_charge_dollar": 55.59, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 55.59, "10th_percentile": 55.59, "90th_percentile": 55.59, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 262.36, "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 $262.36 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 262.36, "10th_percentile": 262.36, "90th_percentile": 262.36, "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 $262.36 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 262.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 262.36, "10th_percentile": 262.36, "90th_percentile": 262.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 262.36, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 262.36, "10th_percentile": 262.36, "90th_percentile": 262.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 55.1, "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": 346.47, "10th_percentile": 346.47, "90th_percentile": 346.47, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 167.65, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 167.65, "10th_percentile": 167.65, "90th_percentile": 167.65, "count": "0", "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": 236.12, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 236.12, "10th_percentile": 236.12, "90th_percentile": 236.12, "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": 131.18, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 131.18, "10th_percentile": 131.18, "90th_percentile": 131.18, "count": "0", "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": 124.36, "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": 124.36, "10th_percentile": 124.36, "90th_percentile": 124.36, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 118.06, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 118.06, "10th_percentile": 118.06, "90th_percentile": 118.06, "count": "0", "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": 215.14, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 215.14, "10th_percentile": 215.14, "90th_percentile": 215.14, "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 $19,355 CASE RATE" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 43.55, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 43.55, "10th_percentile": 43.55, "90th_percentile": 43.55, "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", "standard_charge_dollar": 112.81, "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": 112.81, "10th_percentile": 112.81, "90th_percentile": 112.81, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 168.51, "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": 168.51, "10th_percentile": 168.51, "90th_percentile": 168.51, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 119.37, "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": 119.37, "10th_percentile": 119.37, "90th_percentile": 119.37, "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." } ] } ] }, { "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": "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": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 1949.26, "10th_percentile": 1949.26, "90th_percentile": 1949.26, "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": 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": 1949.26, "10th_percentile": 1949.26, "90th_percentile": 1949.26, "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 SELECT", "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": 1949.26, "10th_percentile": 1949.26, "90th_percentile": 1949.26, "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": "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": 4165.09, "10th_percentile": 4165.09, "90th_percentile": 4165.09, "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 ASA", "standard_charge_dollar": 3790.23, "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": 3790.23, "10th_percentile": 3790.23, "90th_percentile": 3790.23, "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": 4390.0, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "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": 1749.34, "10th_percentile": 1749.34, "90th_percentile": 1749.34, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 6414.23, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 6414.23, "10th_percentile": 6414.23, "90th_percentile": 6414.23, "count": "0", "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": 7497.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 7497.15, "10th_percentile": 7497.15, "90th_percentile": 7497.15, "count": "0", "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": 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": 4048.46, "10th_percentile": 4048.46, "90th_percentile": 4048.46, "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 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": 3748.58, "10th_percentile": 3748.58, "90th_percentile": 3748.58, "count": "0", "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": 5350.47, "10th_percentile": 5350.47, "90th_percentile": 5350.47, "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": "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": 5322.98, "10th_percentile": 5322.98, "90th_percentile": 5322.98, "count": "0", "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": 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": 3948.5, "10th_percentile": 3948.5, "90th_percentile": 3948.5, "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": "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": 3581.97, "10th_percentile": 3581.97, "90th_percentile": 3581.97, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 8330.17, "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 $8,330.17 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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 $8,330.17 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8330.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8330.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% 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": 6664.14, "10th_percentile": 6664.14, "90th_percentile": 6664.14, "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": 6664.14, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6664.14, "10th_percentile": 6664.14, "90th_percentile": 6664.14, "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": 1765.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1765.16, "10th_percentile": 1765.16, "90th_percentile": 1765.16, "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 HMO", "standard_charge_dollar": 1765.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1765.16, "10th_percentile": 1765.16, "90th_percentile": 1765.16, "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": 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": 2274.14, "10th_percentile": 2274.14, "90th_percentile": 2274.14, "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": 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": 2274.14, "10th_percentile": 2274.14, "90th_percentile": 2274.14, "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 MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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_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: $8,330.17 @ 12.8% = $1,066.26 due to $0.00 Claim Price", "median_amount": 1066.26, "10th_percentile": 1066.26, "90th_percentile": 1066.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,330.17 @ 12.8% = $1,066.26 due to $0.00 Claim Price" } ] } ] }, { "description": "AMPLATZER PLUG VASC OCCL 6X7MM NIT", "code_information": [ { "code": "SUP-112018", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1059.67, "maximum": 6383.54, "setting": "outpatient", "gross_charge": 6383.54, "discounted_cash": 4468.48, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1059.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1493.75, "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": 1493.75, "10th_percentile": 1493.75, "90th_percentile": 1493.75, "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": 1493.75, "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": 1493.75, "10th_percentile": 1493.75, "90th_percentile": 1493.75, "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 SELECT", "standard_charge_dollar": 1493.75, "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": 1493.75, "10th_percentile": 1493.75, "90th_percentile": 1493.75, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3191.77, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3191.77, "10th_percentile": 3191.77, "90th_percentile": 3191.77, "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 ASA", "standard_charge_dollar": 2904.51, "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": 2904.51, "10th_percentile": 2904.51, "90th_percentile": 2904.51, "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": 3364.13, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1340.54, "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": 1340.54, "10th_percentile": 1340.54, "90th_percentile": 1340.54, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4915.33, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4915.33, "10th_percentile": 4915.33, "90th_percentile": 4915.33, "count": "0", "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": 5745.19, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5745.19, "10th_percentile": 5745.19, "90th_percentile": 5745.19, "count": "0", "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": 3102.4, "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": 3102.4, "10th_percentile": 3102.4, "90th_percentile": 3102.4, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2872.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2872.59, "10th_percentile": 2872.59, "90th_percentile": 2872.59, "count": "0", "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": 4100.15, "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": 4100.15, "10th_percentile": 4100.15, "90th_percentile": 4100.15, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4079.08, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4079.08, "10th_percentile": 4079.08, "90th_percentile": 4079.08, "count": "0", "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": 3025.8, "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": 3025.8, "10th_percentile": 3025.8, "90th_percentile": 3025.8, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2744.92, "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": 2744.92, "10th_percentile": 2744.92, "90th_percentile": 2744.92, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 6383.54, "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 $6,383.54 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6383.54, "10th_percentile": 6383.54, "90th_percentile": 6383.54, "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 $6,383.54 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6383.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6383.54, "10th_percentile": 6383.54, "90th_percentile": 6383.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6383.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6383.54, "10th_percentile": 6383.54, "90th_percentile": 6383.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 5106.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5106.83, "10th_percentile": 5106.83, "90th_percentile": 5106.83, "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": 5106.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5106.83, "10th_percentile": 5106.83, "90th_percentile": 5106.83, "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": 1352.67, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1352.67, "10th_percentile": 1352.67, "90th_percentile": 1352.67, "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 HMO", "standard_charge_dollar": 1352.67, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1352.67, "10th_percentile": 1352.67, "90th_percentile": 1352.67, "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": 1742.71, "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": 1742.71, "10th_percentile": 1742.71, "90th_percentile": 1742.71, "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": 1742.71, "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": 1742.71, "10th_percentile": 1742.71, "90th_percentile": 1742.71, "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 MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6383.54, "10th_percentile": 6383.54, "90th_percentile": 6383.54, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6383.54, "10th_percentile": 6383.54, "90th_percentile": 6383.54, "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": 6383.54, "10th_percentile": 6383.54, "90th_percentile": 6383.54, "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": 6383.54, "10th_percentile": 6383.54, "90th_percentile": 6383.54, "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_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: $6,383.54 @ 12.8% = $817.09 due to $0.00 Claim Price", "median_amount": 817.09, "10th_percentile": 817.09, "90th_percentile": 817.09, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,383.54 @ 12.8% = $817.09 due to $0.00 Claim Price" } ] } ] }, { "description": "ANCHOR 1.8MM 2 TAPE VERSALOOP", "code_information": [ { "code": "SUP-419059", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 812.22, "maximum": 4892.88, "setting": "outpatient", "gross_charge": 4892.88, "discounted_cash": 3425.02, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 812.22, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3914.3, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3914.3, "10th_percentile": 3914.3, "90th_percentile": 3914.3, "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": 1335.76, "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": 1335.76, "10th_percentile": 1335.76, "90th_percentile": 1335.76, "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 HMO", "standard_charge_dollar": 1036.8, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1036.8, "10th_percentile": 1036.8, "90th_percentile": 1036.8, "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", "standard_charge_dollar": 2103.94, "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": 2103.94, "10th_percentile": 2103.94, "90th_percentile": 2103.94, "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 ASA", "standard_charge_dollar": 2226.26, "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": 2226.26, "10th_percentile": 2226.26, "90th_percentile": 2226.26, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "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": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2377.94, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2578.55, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1144.93, "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": 1144.93, "10th_percentile": 1144.93, "90th_percentile": 1144.93, "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": 1144.93, "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": 1144.93, "10th_percentile": 1144.93, "90th_percentile": 1144.93, "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": 1144.93, "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": 1144.93, "10th_percentile": 1144.93, "90th_percentile": 1144.93, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3914.3, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3914.3, "10th_percentile": 3914.3, "90th_percentile": 3914.3, "count": "0", "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": 1335.76, "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": 1335.76, "10th_percentile": 1335.76, "90th_percentile": 1335.76, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1036.8, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1036.8, "10th_percentile": 1036.8, "90th_percentile": 1036.8, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4892.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4892.88, "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 $4,892.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "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 $4,892.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4892.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4892.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2319.23, "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": 2319.23, "10th_percentile": 2319.23, "90th_percentile": 2319.23, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3142.7, "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": 3142.7, "10th_percentile": 3142.7, "90th_percentile": 3142.7, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 4403.59, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 4403.59, "10th_percentile": 4403.59, "90th_percentile": 4403.59, "count": "0", "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": 1027.5, "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": 1027.5, "10th_percentile": 1027.5, "90th_percentile": 1027.5, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2446.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2446.44, "10th_percentile": 2446.44, "90th_percentile": 2446.44, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 3126.55, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3126.55, "10th_percentile": 3126.55, "90th_percentile": 3126.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3767.52, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3767.52, "10th_percentile": 3767.52, "90th_percentile": 3767.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $4,892.88 @ 12.8% = $626.29 due to $0.00 Claim Price", "median_amount": 626.29, "10th_percentile": 626.29, "90th_percentile": 626.29, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,892.88 @ 12.8% = $626.29 due to $0.00 Claim Price" }, { "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": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "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": 4892.88, "10th_percentile": 4892.88, "90th_percentile": 4892.88, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR KIT TIGHTROPE AR-1588TN-1", "code_information": [ { "code": "SUP-149362", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 629.85, "maximum": 3794.27, "setting": "outpatient", "gross_charge": 3794.27, "discounted_cash": 2655.99, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1844.02, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1999.58, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 887.86, "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": 887.86, "10th_percentile": 887.86, "90th_percentile": 887.86, "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": 887.86, "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": 887.86, "10th_percentile": 887.86, "90th_percentile": 887.86, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3035.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3035.42, "10th_percentile": 3035.42, "90th_percentile": 3035.42, "count": "0", "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": 1035.84, "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": 1035.84, "10th_percentile": 1035.84, "90th_percentile": 1035.84, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 804.01, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 804.01, "10th_percentile": 804.01, "90th_percentile": 804.01, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3794.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3794.27, "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 $3,794.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "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 $3,794.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3794.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1798.48, "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": 1798.48, "10th_percentile": 1798.48, "90th_percentile": 1798.48, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2437.06, "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": 2437.06, "10th_percentile": 2437.06, "90th_percentile": 2437.06, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3414.84, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3414.84, "10th_percentile": 3414.84, "90th_percentile": 3414.84, "count": "0", "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": 796.8, "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": 796.8, "10th_percentile": 796.8, "90th_percentile": 796.8, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1897.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1897.14, "10th_percentile": 1897.14, "90th_percentile": 1897.14, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 2424.54, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2424.54, "10th_percentile": 2424.54, "90th_percentile": 2424.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2921.59, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2921.59, "10th_percentile": 2921.59, "90th_percentile": 2921.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $3,794.27 @ 12.8% = $485.67 due to $0.00 Claim Price", "median_amount": 485.67, "10th_percentile": 485.67, "90th_percentile": 485.67, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,794.27 @ 12.8% = $485.67 due to $0.00 Claim Price" }, { "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": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "count": "0", "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": 629.85, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 887.86, "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": 887.86, "10th_percentile": 887.86, "90th_percentile": 887.86, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3035.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3035.42, "10th_percentile": 3035.42, "90th_percentile": 3035.42, "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": 1035.84, "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": 1035.84, "10th_percentile": 1035.84, "90th_percentile": 1035.84, "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 HMO", "standard_charge_dollar": 804.01, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 804.01, "10th_percentile": 804.01, "90th_percentile": 804.01, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 3794.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1631.54, "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": 1631.54, "10th_percentile": 1631.54, "90th_percentile": 1631.54, "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 ASA", "standard_charge_dollar": 1726.39, "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": 1726.39, "10th_percentile": 1726.39, "90th_percentile": 1726.39, "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": "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": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "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": 3794.27, "10th_percentile": 3794.27, "90th_percentile": 3794.27, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR QUICK ANCHOR+ 212859", "code_information": [ { "code": "SUP-143056", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 764.97, "maximum": 4608.25, "setting": "outpatient", "gross_charge": 4608.25, "discounted_cash": 3225.77, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 764.97, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2239.61, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2428.55, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1078.33, "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": 1078.33, "10th_percentile": 1078.33, "90th_percentile": 1078.33, "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": 1078.33, "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": 1078.33, "10th_percentile": 1078.33, "90th_percentile": 1078.33, "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": 1078.33, "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": 1078.33, "10th_percentile": 1078.33, "90th_percentile": 1078.33, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3686.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3686.6, "10th_percentile": 3686.6, "90th_percentile": 3686.6, "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": 3686.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3686.6, "10th_percentile": 3686.6, "90th_percentile": 3686.6, "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": 1258.05, "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": 1258.05, "10th_percentile": 1258.05, "90th_percentile": 1258.05, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1258.05, "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": 1258.05, "10th_percentile": 1258.05, "90th_percentile": 1258.05, "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 HMO", "standard_charge_dollar": 976.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 976.49, "10th_percentile": 976.49, "90th_percentile": 976.49, "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 HMO", "standard_charge_dollar": 976.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 976.49, "10th_percentile": 976.49, "90th_percentile": 976.49, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4608.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4608.25, "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 $4,608.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "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 $4,608.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4608.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4608.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1981.55, "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": 1981.55, "10th_percentile": 1981.55, "90th_percentile": 1981.55, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2184.31, "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": 2184.31, "10th_percentile": 2184.31, "90th_percentile": 2184.31, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2096.75, "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": 2096.75, "10th_percentile": 2096.75, "90th_percentile": 2096.75, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2959.88, "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": 2959.88, "10th_percentile": 2959.88, "90th_percentile": 2959.88, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 4147.43, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 4147.43, "10th_percentile": 4147.43, "90th_percentile": 4147.43, "count": "0", "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": 967.73, "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": 967.73, "10th_percentile": 967.73, "90th_percentile": 967.73, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2304.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2304.13, "10th_percentile": 2304.13, "90th_percentile": 2304.13, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 2944.67, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2944.67, "10th_percentile": 2944.67, "90th_percentile": 2944.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3548.35, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3548.35, "10th_percentile": 3548.35, "90th_percentile": 3548.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $4,608.25 @ 12.8% = $589.86 due to $0.00 Claim Price", "median_amount": 589.86, "10th_percentile": 589.86, "90th_percentile": 589.86, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,608.25 @ 12.8% = $589.86 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "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": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "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": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "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": 4608.25, "10th_percentile": 4608.25, "90th_percentile": 4608.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR SFT TISS L24MM DIA4.5MM CORT PEEK N ABSRB FOR MED HI", "code_information": [ { "code": "SUP-431192", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 363.9, "maximum": 2192.15, "setting": "outpatient", "gross_charge": 2192.15, "discounted_cash": 1534.5, "payers_information": [ { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1065.38, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 363.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 512.96, "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": 512.96, "10th_percentile": 512.96, "90th_percentile": 512.96, "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": 512.96, "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": 512.96, "10th_percentile": 512.96, "90th_percentile": 512.96, "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 SELECT", "standard_charge_dollar": 512.96, "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": 512.96, "10th_percentile": 512.96, "90th_percentile": 512.96, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1753.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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": 1753.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "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": 598.46, "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": 598.46, "10th_percentile": 598.46, "90th_percentile": 598.46, "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": 598.46, "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": 598.46, "10th_percentile": 598.46, "90th_percentile": 598.46, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 464.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 464.52, "10th_percentile": 464.52, "90th_percentile": 464.52, "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": 464.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 464.52, "10th_percentile": 464.52, "90th_percentile": 464.52, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2192.15, "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 $2,192.15 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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 $2,192.15 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1687.96, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 1687.96, "10th_percentile": 1687.96, "90th_percentile": 1687.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1400.78, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1400.78, "10th_percentile": 1400.78, "90th_percentile": 1400.78, "count": "0", "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": 460.35, "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": 460.35, "10th_percentile": 460.35, "90th_percentile": 460.35, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1408.02, "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": 1408.02, "10th_percentile": 1408.02, "90th_percentile": 1408.02, "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": 1039.08, "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": 1039.08, "10th_percentile": 1039.08, "90th_percentile": 1039.08, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 942.62, "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": 942.62, "10th_percentile": 942.62, "90th_percentile": 942.62, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1096.08, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1096.08, "10th_percentile": 1096.08, "90th_percentile": 1096.08, "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 ASA", "standard_charge_dollar": 997.43, "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": 997.43, "10th_percentile": 997.43, "90th_percentile": 997.43, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1972.94, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1972.94, "10th_percentile": 1972.94, "90th_percentile": 1972.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $2,192.15 @ 12.8% = $280.60 due to $0.00 Claim Price", "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "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: $2,192.15 @ 12.8% = $280.60 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "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": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1155.26, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2192.15, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2192.15, "10th_percentile": 2192.15, "90th_percentile": 2192.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "ANCHOR STR 4.75MM SWVLCK SP PK KL", "code_information": [ { "code": "SUP-436754", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 720.52, "maximum": 4340.46, "setting": "outpatient", "gross_charge": 4340.46, "discounted_cash": 3038.32, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 720.52, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2109.46, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2287.42, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1015.67, "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": 1015.67, "10th_percentile": 1015.67, "90th_percentile": 1015.67, "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": 1015.67, "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": 1015.67, "10th_percentile": 1015.67, "90th_percentile": 1015.67, "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": 1015.67, "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": 1015.67, "10th_percentile": 1015.67, "90th_percentile": 1015.67, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3472.37, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3472.37, "10th_percentile": 3472.37, "90th_percentile": 3472.37, "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": 3472.37, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3472.37, "10th_percentile": 3472.37, "90th_percentile": 3472.37, "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": 1184.95, "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": 1184.95, "10th_percentile": 1184.95, "90th_percentile": 1184.95, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1184.95, "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": 1184.95, "10th_percentile": 1184.95, "90th_percentile": 1184.95, "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 HMO", "standard_charge_dollar": 919.74, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 919.74, "10th_percentile": 919.74, "90th_percentile": 919.74, "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 HMO", "standard_charge_dollar": 919.74, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 919.74, "10th_percentile": 919.74, "90th_percentile": 919.74, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4340.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4340.46, "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 $4,340.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "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 $4,340.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4340.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4340.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1866.4, "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": 1866.4, "10th_percentile": 1866.4, "90th_percentile": 1866.4, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2057.38, "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": 2057.38, "10th_percentile": 2057.38, "90th_percentile": 2057.38, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1974.91, "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": 1974.91, "10th_percentile": 1974.91, "90th_percentile": 1974.91, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2787.88, "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": 2787.88, "10th_percentile": 2787.88, "90th_percentile": 2787.88, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3906.41, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3906.41, "10th_percentile": 3906.41, "90th_percentile": 3906.41, "count": "0", "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": 911.5, "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": 911.5, "10th_percentile": 911.5, "90th_percentile": 911.5, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2170.23, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2170.23, "10th_percentile": 2170.23, "90th_percentile": 2170.23, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 2773.55, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2773.55, "10th_percentile": 2773.55, "90th_percentile": 2773.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3342.15, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3342.15, "10th_percentile": 3342.15, "90th_percentile": 3342.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $4,340.46 @ 12.8% = $555.58 due to $0.00 Claim Price", "median_amount": 555.58, "10th_percentile": 555.58, "90th_percentile": 555.58, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,340.46 @ 12.8% = $555.58 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "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": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "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": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "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": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR SUT PEEK ZIP 5.5MM W/2 STRNDS 2 FF", "code_information": [ { "code": "SUP-139497", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 695.69, "maximum": 4190.93, "setting": "outpatient", "gross_charge": 4190.93, "discounted_cash": 2933.65, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2208.62, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2036.79, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 695.69, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 980.68, "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": 980.68, "10th_percentile": 980.68, "90th_percentile": 980.68, "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": 980.68, "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": 980.68, "10th_percentile": 980.68, "90th_percentile": 980.68, "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": 980.68, "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": 980.68, "10th_percentile": 980.68, "90th_percentile": 980.68, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3352.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3352.74, "10th_percentile": 3352.74, "90th_percentile": 3352.74, "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": 3352.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3352.74, "10th_percentile": 3352.74, "90th_percentile": 3352.74, "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": 1144.12, "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": 1144.12, "10th_percentile": 1144.12, "90th_percentile": 1144.12, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1144.12, "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": 1144.12, "10th_percentile": 1144.12, "90th_percentile": 1144.12, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 888.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 888.06, "10th_percentile": 888.06, "90th_percentile": 888.06, "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": 888.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 888.06, "10th_percentile": 888.06, "90th_percentile": 888.06, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 4190.93, "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 $4,190.93 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "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 $4,190.93 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4190.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4190.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4190.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3227.02, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3227.02, "10th_percentile": 3227.02, "90th_percentile": 3227.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2678.0, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2678.0, "10th_percentile": 2678.0, "90th_percentile": 2678.0, "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": 1802.1, "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": 1802.1, "10th_percentile": 1802.1, "90th_percentile": 1802.1, "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": 2095.47, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2095.47, "10th_percentile": 2095.47, "90th_percentile": 2095.47, "count": "0", "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": 2691.83, "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": 2691.83, "10th_percentile": 2691.83, "90th_percentile": 2691.83, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1906.87, "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": 1906.87, "10th_percentile": 1906.87, "90th_percentile": 1906.87, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3771.84, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3771.84, "10th_percentile": 3771.84, "90th_percentile": 3771.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1986.5, "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": 1986.5, "10th_percentile": 1986.5, "90th_percentile": 1986.5, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 880.1, "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": 880.1, "10th_percentile": 880.1, "90th_percentile": 880.1, "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": "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: $4,190.93 @ 12.8% = $536.44 due to $0.00 Claim Price", "median_amount": 536.44, "10th_percentile": 536.44, "90th_percentile": 536.44, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,190.93 @ 12.8% = $536.44 due to $0.00 Claim Price" }, { "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": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "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": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "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": 4190.93, "10th_percentile": 4190.93, "90th_percentile": 4190.93, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR SUT TENDSIS SWVL LOK 7MM PEEK", "code_information": [ { "code": "SUP-150136", "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": "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": "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": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "count": "0", "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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": 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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": "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": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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 $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "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": 2565.69, "10th_percentile": 2565.69, "90th_percentile": 2565.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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": 2129.19, "10th_percentile": 2129.19, "90th_percentile": 2129.19, "count": "0", "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": 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": 699.73, "10th_percentile": 699.73, "90th_percentile": 699.73, "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": "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": 2140.19, "10th_percentile": 2140.19, "90th_percentile": 2140.19, "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": 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": 1579.4, "10th_percentile": 1579.4, "90th_percentile": 1579.4, "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": "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": 1432.79, "10th_percentile": 1432.79, "90th_percentile": 1432.79, "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": "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": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "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 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": 1516.09, "10th_percentile": 1516.09, "90th_percentile": 1516.09, "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": "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": 2998.86, "10th_percentile": 2998.86, "90th_percentile": 2998.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $3,332.07 @ 12.8% = $426.50 due to $0.00 Claim Price", "median_amount": 426.5, "10th_percentile": 426.5, "90th_percentile": 426.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR SUTURE 3.4MM DBL ARMED PEEK HEALIX TRANSTEND", "code_information": [ { "code": "SUP-374682", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 899.55, "maximum": 5418.99, "setting": "outpatient", "gross_charge": 5418.99, "discounted_cash": 3793.29, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 899.55, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1268.04, "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": 1268.04, "10th_percentile": 1268.04, "90th_percentile": 1268.04, "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": 1268.04, "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": 1268.04, "10th_percentile": 1268.04, "90th_percentile": 1268.04, "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": 1268.04, "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": 1268.04, "10th_percentile": 1268.04, "90th_percentile": 1268.04, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4335.19, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4335.19, "10th_percentile": 4335.19, "90th_percentile": 4335.19, "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": 1479.38, "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": 1479.38, "10th_percentile": 1479.38, "90th_percentile": 1479.38, "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 HMO", "standard_charge_dollar": 1148.28, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1148.28, "10th_percentile": 1148.28, "90th_percentile": 1148.28, "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 HMO", "standard_charge_dollar": 1148.28, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1148.28, "10th_percentile": 1148.28, "90th_percentile": 1148.28, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 5418.99, "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 $5,418.99 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "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 $5,418.99 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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5418.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2330.17, "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": 2330.17, "10th_percentile": 2330.17, "90th_percentile": 2330.17, "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 ASA", "standard_charge_dollar": 2465.64, "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": 2465.64, "10th_percentile": 2465.64, "90th_percentile": 2465.64, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "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": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "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": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2855.81, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2633.63, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4335.19, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4335.19, "10th_percentile": 4335.19, "90th_percentile": 4335.19, "count": "0", "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": 1479.38, "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": 1479.38, "10th_percentile": 1479.38, "90th_percentile": 1479.38, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5418.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5418.99, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4172.62, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4172.62, "10th_percentile": 4172.62, "90th_percentile": 4172.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3462.73, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3462.73, "10th_percentile": 3462.73, "90th_percentile": 3462.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2709.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2709.5, "10th_percentile": 2709.5, "90th_percentile": 2709.5, "count": "0", "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": 3480.62, "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": 3480.62, "10th_percentile": 3480.62, "90th_percentile": 3480.62, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 4877.09, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 4877.09, "10th_percentile": 4877.09, "90th_percentile": 4877.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2568.6, "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": 2568.6, "10th_percentile": 2568.6, "90th_percentile": 2568.6, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1137.99, "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": 1137.99, "10th_percentile": 1137.99, "90th_percentile": 1137.99, "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": "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: $5,418.99 @ 12.8% = $693.63 due to $0.00 Claim Price", "median_amount": 693.63, "10th_percentile": 693.63, "90th_percentile": 693.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,418.99 @ 12.8% = $693.63 due to $0.00 Claim Price" }, { "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": 5418.99, "10th_percentile": 5418.99, "90th_percentile": 5418.99, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR SUTURE 5.5", "code_information": [ { "code": "SUP-378618", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 436.68, "maximum": 2630.58, "setting": "outpatient", "gross_charge": 2630.58, "discounted_cash": 1841.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1386.32, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1278.46, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 436.68, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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 SELECT", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "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": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "count": "0", "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2630.58, "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 $2,630.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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 $2,630.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2025.55, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2025.55, "10th_percentile": 2025.55, "90th_percentile": 2025.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1680.94, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1680.94, "10th_percentile": 1680.94, "90th_percentile": 1680.94, "count": "0", "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": 552.42, "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": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1689.62, "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": 1689.62, "10th_percentile": 1689.62, "90th_percentile": 1689.62, "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 CORE", "standard_charge_dollar": 1246.89, "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": 1246.89, "10th_percentile": 1246.89, "90th_percentile": 1246.89, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1131.15, "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": 1131.15, "10th_percentile": 1131.15, "90th_percentile": 1131.15, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1315.29, "10th_percentile": 1315.29, "90th_percentile": 1315.29, "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 ASA", "standard_charge_dollar": 1196.91, "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": 1196.91, "10th_percentile": 1196.91, "90th_percentile": 1196.91, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2367.52, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2367.52, "10th_percentile": 2367.52, "90th_percentile": 2367.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price", "median_amount": 336.71, "10th_percentile": 336.71, "90th_percentile": 336.71, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANCHOR SUTURE 5MM ORTHOCORD FASTIN RC NEEDLE STERILE", "code_information": [ { "code": "SUP-416212", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 574.96, "maximum": 3463.6, "setting": "outpatient", "gross_charge": 3463.6, "discounted_cash": 2424.52, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1825.32, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2770.88, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2770.88, "10th_percentile": 2770.88, "90th_percentile": 2770.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3463.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3463.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2224.67, "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": 2224.67, "10th_percentile": 2224.67, "90th_percentile": 2224.67, "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": 1641.75, "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": 1641.75, "10th_percentile": 1641.75, "90th_percentile": 1641.75, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1731.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1731.8, "10th_percentile": 1731.8, "90th_percentile": 1731.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "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": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "count": "0", "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": 574.96, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1683.31, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 810.48, "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": 810.48, "10th_percentile": 810.48, "90th_percentile": 810.48, "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": 810.48, "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": 810.48, "10th_percentile": 810.48, "90th_percentile": 810.48, "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": 810.48, "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": 810.48, "10th_percentile": 810.48, "90th_percentile": 810.48, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2770.88, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2770.88, "10th_percentile": 2770.88, "90th_percentile": 2770.88, "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": 945.56, "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": 945.56, "10th_percentile": 945.56, "90th_percentile": 945.56, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 945.56, "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": 945.56, "10th_percentile": 945.56, "90th_percentile": 945.56, "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 HMO", "standard_charge_dollar": 733.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 733.94, "10th_percentile": 733.94, "90th_percentile": 733.94, "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 HMO", "standard_charge_dollar": 733.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 733.94, "10th_percentile": 733.94, "90th_percentile": 733.94, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3463.6, "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 $3,463.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "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 $3,463.60 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": 3463.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1489.35, "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": 1489.35, "10th_percentile": 1489.35, "90th_percentile": 1489.35, "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 ASA", "standard_charge_dollar": 1575.94, "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": 1575.94, "10th_percentile": 1575.94, "90th_percentile": 1575.94, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3117.24, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3117.24, "10th_percentile": 3117.24, "90th_percentile": 3117.24, "count": "0", "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": 727.36, "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": 727.36, "10th_percentile": 727.36, "90th_percentile": 727.36, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2213.24, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2213.24, "10th_percentile": 2213.24, "90th_percentile": 2213.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2666.97, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 2666.97, "10th_percentile": 2666.97, "90th_percentile": 2666.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $3,463.60 @ 12.8% = $443.34 due to $0.00 Claim Price", "median_amount": 443.34, "10th_percentile": 443.34, "90th_percentile": 443.34, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $3,463.60 @ 12.8% = $443.34 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "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": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "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": 3463.6, "10th_percentile": 3463.6, "90th_percentile": 3463.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ANGIOPLASTY PACK LARGE BORE", "code_information": [ { "code": "SUP-11249", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 18.63, "maximum": 112.24, "setting": "outpatient", "gross_charge": 112.24, "discounted_cash": 78.57, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 89.79, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 89.79, "10th_percentile": 89.79, "90th_percentile": 89.79, "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": 89.79, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 89.79, "10th_percentile": 89.79, "90th_percentile": 89.79, "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": 23.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 23.78, "10th_percentile": 23.78, "90th_percentile": 23.78, "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 HMO", "standard_charge_dollar": 23.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 23.78, "10th_percentile": 23.78, "90th_percentile": 23.78, "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": 30.65, "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": 30.65, "10th_percentile": 30.65, "90th_percentile": 30.65, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 30.65, "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": 30.65, "10th_percentile": 30.65, "90th_percentile": 30.65, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 112.24, "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 $112.24 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "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 $112.24 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": 24.7, "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": 24.7, "10th_percentile": 24.7, "90th_percentile": 24.7, "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": 23.53, "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": 23.53, "10th_percentile": 23.53, "90th_percentile": 23.53, "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": 26.12, "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": 26.12, "10th_percentile": 26.12, "90th_percentile": 26.12, "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": 50.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 50.51, "10th_percentile": 50.51, "90th_percentile": 50.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 56.12, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 56.12, "10th_percentile": 56.12, "90th_percentile": 56.12, "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", "standard_charge_dollar": 48.26, "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": 48.26, "10th_percentile": 48.26, "90th_percentile": 48.26, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 18.63, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 18.63, "10th_percentile": 18.63, "90th_percentile": 18.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 101.02, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 101.02, "10th_percentile": 101.02, "90th_percentile": 101.02, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 71.72, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 71.72, "10th_percentile": 71.72, "90th_percentile": 71.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 92.04, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 92.04, "10th_percentile": 92.04, "90th_percentile": 92.04, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 54.55, "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": 54.55, "10th_percentile": 54.55, "90th_percentile": 54.55, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 53.2, "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": 53.2, "10th_percentile": 53.2, "90th_percentile": 53.2, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 112.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 72.09, "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": 72.09, "10th_percentile": 72.09, "90th_percentile": 72.09, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 112.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 23.57, "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": 23.57, "10th_percentile": 23.57, "90th_percentile": 23.57, "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 ASA", "standard_charge_dollar": 51.07, "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": 51.07, "10th_percentile": 51.07, "90th_percentile": 51.07, "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": 59.15, "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": 59.15, "10th_percentile": 59.15, "90th_percentile": 59.15, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "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": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "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": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "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": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AORTIC VALVE AVALUS BOVINE PERICARDIAL 27MM", "code_information": [ { "code": "SUP-358606", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 7277.94, "maximum": 43843.0, "setting": "outpatient", "gross_charge": 43843.0, "discounted_cash": 30690.1, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 7277.94, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 21921.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 21921.5, "10th_percentile": 21921.5, "90th_percentile": 21921.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 33759.11, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 33759.11, "10th_percentile": 33759.11, "90th_percentile": 33759.11, "count": "0", "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": 21307.7, "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": 21307.7, "10th_percentile": 21307.7, "90th_percentile": 21307.7, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 19948.57, "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": 19948.57, "10th_percentile": 19948.57, "90th_percentile": 19948.57, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 39458.7, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 39458.7, "10th_percentile": 39458.7, "90th_percentile": 39458.7, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 28015.68, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 28015.68, "10th_percentile": 28015.68, "90th_percentile": 28015.68, "count": "0", "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": 9207.03, "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": 9207.03, "10th_percentile": 9207.03, "90th_percentile": 9207.03, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 19729.35, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 19729.35, "10th_percentile": 19729.35, "90th_percentile": 19729.35, "count": "0", "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": 18852.49, "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": 18852.49, "10th_percentile": 18852.49, "90th_percentile": 18852.49, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 43843.0, "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 $43,843.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 43843.0, "10th_percentile": 43843.0, "90th_percentile": 43843.0, "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 $43,843.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 35074.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 35074.4, "10th_percentile": 35074.4, "90th_percentile": 35074.4, "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": 11969.14, "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": 11969.14, "10th_percentile": 11969.14, "90th_percentile": 11969.14, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 11969.14, "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": 11969.14, "10th_percentile": 11969.14, "90th_percentile": 11969.14, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 9290.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 9290.33, "10th_percentile": 9290.33, "90th_percentile": 9290.33, "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": 9290.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 9290.33, "10th_percentile": 9290.33, "90th_percentile": 9290.33, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 10259.26, "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": 10259.26, "10th_percentile": 10259.26, "90th_percentile": 10259.26, "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": 10259.26, "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": 10259.26, "10th_percentile": 10259.26, "90th_percentile": 10259.26, "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 SELECT", "standard_charge_dollar": 10259.26, "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": 10259.26, "10th_percentile": 10259.26, "90th_percentile": 10259.26, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 43843.0, "10th_percentile": 43843.0, "90th_percentile": 43843.0, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 43843.0, "10th_percentile": 43843.0, "90th_percentile": 43843.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 43843.0, "10th_percentile": 43843.0, "90th_percentile": 43843.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 43843.0, "10th_percentile": 43843.0, "90th_percentile": 43843.0, "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_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: $43,843.00 @ 12.8% = $5,611.90 due to $0.00 Claim Price", "median_amount": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43,843.00 @ 12.8% = $5,611.90 due to $0.00 Claim Price" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 23105.26, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 28160.36, "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": 28160.36, "10th_percentile": 28160.36, "90th_percentile": 28160.36, "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": 20781.58, "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": 20781.58, "10th_percentile": 20781.58, "90th_percentile": 20781.58, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 43843.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 43843.0, "10th_percentile": 43843.0, "90th_percentile": 43843.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 43843.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 43843.0, "10th_percentile": 43843.0, "90th_percentile": 43843.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 35074.4, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 35074.4, "10th_percentile": 35074.4, "90th_percentile": 35074.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 8211.3, "maximum": 16649.66, "setting": "inpatient", "gross_charge": 69747.63, "discounted_cash": 48823.34, "payers_information": [ { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 16649.66, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 66285.59, "10th_percentile": 66285.59, "90th_percentile": 66285.59, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 12669.54, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12669.54, "10th_percentile": 12669.54, "90th_percentile": 12669.54, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 16649.66, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 66285.59, "10th_percentile": 66285.59, "90th_percentile": 66285.59, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 14260.67, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 12,458.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE STOP LOSS & LESSOR OF 9*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14260.67, "10th_percentile": 14260.67, "90th_percentile": 14260.67, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 13594.46, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 11,876.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE PREF STOP LOSS & LESSOR*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13594.46, "10th_percentile": 13594.46, "90th_percentile": 13594.46, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 13327.74, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 11,643.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE SELECT STOP LOSS & LESS*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13327.74, "10th_percentile": 13327.74, "90th_percentile": 13327.74, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 12669.54, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.1447, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 12669.54, "10th_percentile": 12669.54, "90th_percentile": 12669.54, "count": "1 through 10", "methodology": "case rate" }, { "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, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 69764.61, "10th_percentile": 69764.61, "90th_percentile": 69764.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services; 100% Billed", "median_amount": 69764.61, "10th_percentile": 69764.61, "90th_percentile": 69764.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All IP Services - OON; 100% Billed", "median_amount": 69764.61, "10th_percentile": 69764.61, "90th_percentile": 69764.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; IP Services; 65% Billed", "median_amount": 45347.0, "10th_percentile": 45347.0, "90th_percentile": 45347.0, "count": "1 through 10", "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, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 59299.92, "10th_percentile": 59299.92, "90th_percentile": 59299.92, "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 anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 50230.51, "10th_percentile": 50230.51, "90th_percentile": 50230.51, "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 anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 11580.93, "10th_percentile": 11580.93, "90th_percentile": 11580.93, "count": "1 through 10", "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, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 49881.72, "10th_percentile": 49881.72, "90th_percentile": 49881.72, "count": "1 through 10", "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, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 49881.72, "10th_percentile": 49881.72, "90th_percentile": 49881.72, "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.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; Inpatient Services; 50% Billed", "median_amount": 34882.31, "10th_percentile": 34882.31, "90th_percentile": 34882.31, "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.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; 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": 21208.44, "10th_percentile": 21208.44, "90th_percentile": 21208.44, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_dollar": 8211.3, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.14, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $9,896.41; Total: $9,896.41", "median_amount": 9896.41, "10th_percentile": 9896.41, "90th_percentile": 9896.41, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.14, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $9,896.41; Total: $9,896.41" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 8211.3, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.14, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $9,896.41; Total: $9,896.41", "median_amount": 9896.41, "10th_percentile": 9896.41, "90th_percentile": 9896.41, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.14, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $9,896.41; Total: $9,896.41" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_dollar": 8211.3, "standard_charge_algorithm": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.14, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $8,898.21; Total: $8,898.21 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8898.21, "10th_percentile": 8898.21, "90th_percentile": 8898.21, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.740673420; Using historical claim(s); Scope: All Financial Classes; Cases: 5; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.14, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $8,898.21; Total: $8,898.21 Paid at contractual rate, which is 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": "ARCHON SCR SPNL 4.0X13MM SD FIXED 8780713", "code_information": [ { "code": "SUP-324755", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 109.17, "maximum": 657.65, "setting": "outpatient", "gross_charge": 657.65, "discounted_cash": 460.35, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 109.17, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 319.62, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 346.58, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 153.89, "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": 153.89, "10th_percentile": 153.89, "90th_percentile": 153.89, "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": 153.89, "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": 153.89, "10th_percentile": 153.89, "90th_percentile": 153.89, "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": 153.89, "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": 153.89, "10th_percentile": 153.89, "90th_percentile": 153.89, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 526.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 526.12, "10th_percentile": 526.12, "90th_percentile": 526.12, "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": 526.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 526.12, "10th_percentile": 526.12, "90th_percentile": 526.12, "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": 179.54, "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": 179.54, "10th_percentile": 179.54, "90th_percentile": 179.54, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 179.54, "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": 179.54, "10th_percentile": 179.54, "90th_percentile": 179.54, "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 HMO", "standard_charge_dollar": 139.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 139.36, "10th_percentile": 139.36, "90th_percentile": 139.36, "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 HMO", "standard_charge_dollar": 139.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 139.36, "10th_percentile": 139.36, "90th_percentile": 139.36, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 657.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 657.65, "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 $657.65 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "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 $657.65 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 657.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 657.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 282.79, "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": 282.79, "10th_percentile": 282.79, "90th_percentile": 282.79, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 311.73, "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": 311.73, "10th_percentile": 311.73, "90th_percentile": 311.73, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 299.23, "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": 299.23, "10th_percentile": 299.23, "90th_percentile": 299.23, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 422.41, "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": 422.41, "10th_percentile": 422.41, "90th_percentile": 422.41, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 591.89, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 591.89, "10th_percentile": 591.89, "90th_percentile": 591.89, "count": "0", "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": 138.11, "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": 138.11, "10th_percentile": 138.11, "90th_percentile": 138.11, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 328.83, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 328.83, "10th_percentile": 328.83, "90th_percentile": 328.83, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 420.24, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 420.24, "10th_percentile": 420.24, "90th_percentile": 420.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 506.39, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 506.39, "10th_percentile": 506.39, "90th_percentile": 506.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $657.65 @ 12.8% = $84.18 due to $0.00 Claim Price", "median_amount": 84.18, "10th_percentile": 84.18, "90th_percentile": 84.18, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $657.65 @ 12.8% = $84.18 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "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": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "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": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "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": 657.65, "10th_percentile": 657.65, "90th_percentile": 657.65, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARGATROBAN 100 MG/ML IV SOLN", "drug_information": { "unit": 2.5, "type": "ML" }, "code_information": [ { "code": "RX-28947", "type": "CDM" }, { "code": "J0883", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00143-9674-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 200.65, "maximum": 1208.75, "setting": "outpatient", "gross_charge": 1208.75, "discounted_cash": 846.12, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 282.85, "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": 282.85, "10th_percentile": 282.85, "90th_percentile": 282.85, "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": 282.85, "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": 282.85, "10th_percentile": 282.85, "90th_percentile": 282.85, "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 SELECT", "standard_charge_dollar": 282.85, "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": 282.85, "10th_percentile": 282.85, "90th_percentile": 282.85, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 967.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 967.0, "10th_percentile": 967.0, "90th_percentile": 967.0, "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": 967.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 967.0, "10th_percentile": 967.0, "90th_percentile": 967.0, "count": "0", "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": 256.13, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 256.13, "10th_percentile": 256.13, "90th_percentile": 256.13, "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": 256.13, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 256.13, "10th_percentile": 256.13, "90th_percentile": 256.13, "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": 329.99, "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": 329.99, "10th_percentile": 329.99, "90th_percentile": 329.99, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 329.99, "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": 329.99, "10th_percentile": 329.99, "90th_percentile": 329.99, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1208.75, "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 $1,208.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1208.75, "10th_percentile": 1208.75, "90th_percentile": 1208.75, "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 $1,208.75 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1208.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1208.75, "10th_percentile": 1208.75, "90th_percentile": 1208.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1208.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1208.75, "10th_percentile": 1208.75, "90th_percentile": 1208.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1087.88, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1087.88, "10th_percentile": 1087.88, "90th_percentile": 1087.88, "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": 604.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 604.38, "10th_percentile": 604.38, "90th_percentile": 604.38, "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 ASA", "standard_charge_dollar": 549.98, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 549.98, "10th_percentile": 549.98, "90th_percentile": 549.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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 PLATINUM/CHC ELITE", "standard_charge_dollar": 772.39, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 772.39, "10th_percentile": 772.39, "90th_percentile": 772.39, "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 NM EMPLOYEES", "standard_charge_dollar": 200.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 200.65, "10th_percentile": 200.65, "90th_percentile": 200.65, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 543.94, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 543.94, "10th_percentile": 543.94, "90th_percentile": 543.94, "count": "0", "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": 991.18, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 991.18, "10th_percentile": 991.18, "90th_percentile": 991.18, "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 $19,355 CASE RATE" }, { "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: $1,208.75 @ 12.8% = $154.72 due to $0.00 Claim Price", "median_amount": 154.72, "10th_percentile": 154.72, "90th_percentile": 154.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,208.75 @ 12.8% = $154.72 due to $0.00 Claim Price" }, { "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": 1208.75, "10th_percentile": 1208.75, "90th_percentile": 1208.75, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1208.75, "10th_percentile": 1208.75, "90th_percentile": 1208.75, "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": 1208.75, "10th_percentile": 1208.75, "90th_percentile": 1208.75, "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": 1208.75, "10th_percentile": 1208.75, "90th_percentile": 1208.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARMADA 35 OTW BALLOON 7.0 X 40MM X 80CM", "code_information": [ { "code": "SUP-137687", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 152.84, "maximum": 920.7, "setting": "outpatient", "gross_charge": 920.7, "discounted_cash": 644.49, "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": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 195.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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": 251.35, "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": 251.35, "10th_percentile": 251.35, "90th_percentile": 251.35, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 736.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 736.56, "10th_percentile": 736.56, "90th_percentile": 736.56, "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 ASA", "standard_charge_dollar": 418.92, "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": 418.92, "10th_percentile": 418.92, "90th_percentile": 418.92, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 395.9, "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": 395.9, "10th_percentile": 395.9, "90th_percentile": 395.9, "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": 152.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 152.84, "10th_percentile": 152.84, "90th_percentile": 152.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 485.21, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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_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: $920.70 @ 12.8% = $117.85 due to $0.00 Claim Price", "median_amount": 117.85, "10th_percentile": 117.85, "90th_percentile": 117.85, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $920.70 @ 12.8% = $117.85 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 215.44, "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": 215.44, "10th_percentile": 215.44, "90th_percentile": 215.44, "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": 215.44, "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": 215.44, "10th_percentile": 215.44, "90th_percentile": 215.44, "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 SELECT", "standard_charge_dollar": 215.44, "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": 215.44, "10th_percentile": 215.44, "90th_percentile": 215.44, "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": 251.35, "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": 251.35, "10th_percentile": 251.35, "90th_percentile": 251.35, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 736.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 736.56, "10th_percentile": 736.56, "90th_percentile": 736.56, "count": "0", "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": 195.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 920.7, "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 $920.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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 $920.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 920.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 920.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 193.35, "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": 193.35, "10th_percentile": 193.35, "90th_percentile": 193.35, "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": 447.46, "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": 447.46, "10th_percentile": 447.46, "90th_percentile": 447.46, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 460.35, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 460.35, "10th_percentile": 460.35, "90th_percentile": 460.35, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 588.33, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 588.33, "10th_percentile": 588.33, "90th_percentile": 588.33, "count": "0", "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": 436.41, "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": 436.41, "10th_percentile": 436.41, "90th_percentile": 436.41, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 414.32, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 414.32, "10th_percentile": 414.32, "90th_percentile": 414.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 828.63, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 828.63, "10th_percentile": 828.63, "90th_percentile": 828.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 591.37, "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": 591.37, "10th_percentile": 591.37, "90th_percentile": 591.37, "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": 754.97, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 754.97, "10th_percentile": 754.97, "90th_percentile": 754.97, "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 $19,355 CASE RATE" } ] } ] }, { "description": "ARTERIAL LINE TRANSDUCER SINGLE", "code_information": [ { "code": "SUP-303387", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 16.77, "maximum": 101.01, "setting": "outpatient", "gross_charge": 101.01, "discounted_cash": 70.71, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 27.59, "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": 27.59, "10th_percentile": 27.59, "90th_percentile": 27.59, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 27.59, "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": 27.59, "10th_percentile": 27.59, "90th_percentile": 27.59, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 21.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 21.4, "10th_percentile": 21.4, "90th_percentile": 21.4, "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 HMO", "standard_charge_dollar": 21.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 21.4, "10th_percentile": 21.4, "90th_percentile": 21.4, "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": 80.81, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 80.81, "10th_percentile": 80.81, "90th_percentile": 80.81, "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": 80.81, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 80.81, "10th_percentile": 80.81, "90th_percentile": 80.81, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 101.01, "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 $101.01 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "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 $101.01 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": 23.51, "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": 23.51, "10th_percentile": 23.51, "90th_percentile": 23.51, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 22.23, "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": 22.23, "10th_percentile": 22.23, "90th_percentile": 22.23, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 45.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 45.45, "10th_percentile": 45.45, "90th_percentile": 45.45, "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": 21.17, "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": 21.17, "10th_percentile": 21.17, "90th_percentile": 21.17, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 90.91, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 90.91, "10th_percentile": 90.91, "90th_percentile": 90.91, "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": 50.51, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 50.51, "10th_percentile": 50.51, "90th_percentile": 50.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 82.83, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 82.83, "10th_percentile": 82.83, "90th_percentile": 82.83, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 49.09, "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": 49.09, "10th_percentile": 49.09, "90th_percentile": 49.09, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 101.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 64.55, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 64.55, "10th_percentile": 64.55, "90th_percentile": 64.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 101.01, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 16.77, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 16.77, "10th_percentile": 16.77, "90th_percentile": 16.77, "count": "0", "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": 64.88, "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": 64.88, "10th_percentile": 64.88, "90th_percentile": 64.88, "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": 53.23, "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": 53.23, "10th_percentile": 53.23, "90th_percentile": 53.23, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 47.88, "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": 47.88, "10th_percentile": 47.88, "90th_percentile": 47.88, "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": 21.21, "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": 21.21, "10th_percentile": 21.21, "90th_percentile": 21.21, "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": 43.43, "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": 43.43, "10th_percentile": 43.43, "90th_percentile": 43.43, "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 ASA", "standard_charge_dollar": 45.96, "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": 45.96, "10th_percentile": 45.96, "90th_percentile": 45.96, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "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": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "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": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "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": 101.01, "10th_percentile": 101.01, "90th_percentile": 101.01, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARTERIAL WRIST SUPPORT ADULT (29980)", "code_information": [ { "code": "SUP-601", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 6.86, "maximum": 41.3, "setting": "outpatient", "gross_charge": 41.3, "discounted_cash": 28.91, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 33.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 33.04, "10th_percentile": 33.04, "90th_percentile": 33.04, "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": 33.04, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 33.04, "10th_percentile": 33.04, "90th_percentile": 33.04, "count": "0", "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": 11.28, "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": 11.28, "10th_percentile": 11.28, "90th_percentile": 11.28, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 11.28, "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": 11.28, "10th_percentile": 11.28, "90th_percentile": 11.28, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 8.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "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 HMO", "standard_charge_dollar": 8.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 8.75, "10th_percentile": 8.75, "90th_percentile": 8.75, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 41.3, "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 $41.30 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "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 $41.30 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": 9.09, "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": 9.09, "10th_percentile": 9.09, "90th_percentile": 9.09, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 18.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 18.59, "10th_percentile": 18.59, "90th_percentile": 18.59, "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 OPTIONS", "standard_charge_dollar": 9.61, "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": 9.61, "10th_percentile": 9.61, "90th_percentile": 9.61, "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 BLUECHOICE SELECT", "standard_charge_dollar": 8.66, "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": 8.66, "10th_percentile": 8.66, "90th_percentile": 8.66, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 26.53, "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": 26.53, "10th_percentile": 26.53, "90th_percentile": 26.53, "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 BROAD", "standard_charge_dollar": 20.07, "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": 20.07, "10th_percentile": 20.07, "90th_percentile": 20.07, "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": 33.87, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 33.87, "10th_percentile": 33.87, "90th_percentile": 33.87, "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": 20.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 20.65, "10th_percentile": 20.65, "90th_percentile": 20.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 41.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 6.86, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 6.86, "10th_percentile": 6.86, "90th_percentile": 6.86, "count": "0", "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": 19.58, "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": 19.58, "10th_percentile": 19.58, "90th_percentile": 19.58, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 18.79, "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": 18.79, "10th_percentile": 18.79, "90th_percentile": 18.79, "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": 21.77, "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": 21.77, "10th_percentile": 21.77, "90th_percentile": 21.77, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 41.3, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 8.67, "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": 8.67, "10th_percentile": 8.67, "90th_percentile": 8.67, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 26.39, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 26.39, "10th_percentile": 26.39, "90th_percentile": 26.39, "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": 17.76, "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": 17.76, "10th_percentile": 17.76, "90th_percentile": 17.76, "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": 37.17, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 37.17, "10th_percentile": 37.17, "90th_percentile": 37.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "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": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "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": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 41.3, "10th_percentile": 41.3, "90th_percentile": 41.3, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARTHREX PASSPORT BUTTON CANNULA ARTHSCP 10MMX4CM AR-6592-10-40", "code_information": [ { "code": "SUP-135669", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 46.58, "maximum": 280.6, "setting": "outpatient", "gross_charge": 280.6, "discounted_cash": 196.42, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 224.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 224.48, "10th_percentile": 224.48, "90th_percentile": 224.48, "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": 224.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 224.48, "10th_percentile": 224.48, "90th_percentile": 224.48, "count": "0", "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": 76.63, "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": 76.63, "10th_percentile": 76.63, "90th_percentile": 76.63, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 76.63, "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": 76.63, "10th_percentile": 76.63, "90th_percentile": 76.63, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 59.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 59.46, "10th_percentile": 59.46, "90th_percentile": 59.46, "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 HMO", "standard_charge_dollar": 59.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 59.46, "10th_percentile": 59.46, "90th_percentile": 59.46, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 280.6, "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 $280.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "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 $280.60 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": 61.76, "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": 61.76, "10th_percentile": 61.76, "90th_percentile": 61.76, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 126.27, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 126.27, "10th_percentile": 126.27, "90th_percentile": 126.27, "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 OPTIONS", "standard_charge_dollar": 65.3, "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": 65.3, "10th_percentile": 65.3, "90th_percentile": 65.3, "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 BLUECHOICE SELECT", "standard_charge_dollar": 58.81, "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": 58.81, "10th_percentile": 58.81, "90th_percentile": 58.81, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 180.23, "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": 180.23, "10th_percentile": 180.23, "90th_percentile": 180.23, "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 BROAD", "standard_charge_dollar": 136.37, "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": 136.37, "10th_percentile": 136.37, "90th_percentile": 136.37, "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": 230.09, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 230.09, "10th_percentile": 230.09, "90th_percentile": 230.09, "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": 140.3, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 140.3, "10th_percentile": 140.3, "90th_percentile": 140.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 280.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 46.58, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 46.58, "10th_percentile": 46.58, "90th_percentile": 46.58, "count": "0", "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": 133.0, "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": 133.0, "10th_percentile": 133.0, "90th_percentile": 133.0, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 127.67, "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": 127.67, "10th_percentile": 127.67, "90th_percentile": 127.67, "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": 147.88, "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": 147.88, "10th_percentile": 147.88, "90th_percentile": 147.88, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 280.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 58.93, "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": 58.93, "10th_percentile": 58.93, "90th_percentile": 58.93, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 179.3, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 179.3, "10th_percentile": 179.3, "90th_percentile": 179.3, "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": 120.66, "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": 120.66, "10th_percentile": 120.66, "90th_percentile": 120.66, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 252.54, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "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": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "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": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "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": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARTHROSCOPIC SLINGSHOT 70 UP MED DEVICE STRYKER CAT02590", "code_information": [ { "code": "SUP-192871", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 679.6, "maximum": 4093.97, "setting": "outpatient", "gross_charge": 4093.97, "discounted_cash": 2865.78, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3275.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3275.18, "10th_percentile": 3275.18, "90th_percentile": 3275.18, "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": 1118.06, "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": 1118.06, "10th_percentile": 1118.06, "90th_percentile": 1118.06, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 867.51, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 867.51, "10th_percentile": 867.51, "90th_percentile": 867.51, "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": 679.6, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 679.6, "10th_percentile": 679.6, "90th_percentile": 679.6, "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 ASA", "standard_charge_dollar": 1862.76, "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": 1862.76, "10th_percentile": 1862.76, "90th_percentile": 1862.76, "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": 1760.41, "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": 1760.41, "10th_percentile": 1760.41, "90th_percentile": 1760.41, "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 ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "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": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "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": 3275.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3275.18, "10th_percentile": 3275.18, "90th_percentile": 3275.18, "count": "0", "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": 867.51, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 867.51, "10th_percentile": 867.51, "90th_percentile": 867.51, "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": 1118.06, "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": 1118.06, "10th_percentile": 1118.06, "90th_percentile": 1118.06, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 4093.97, "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 $4,093.97 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "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 $4,093.97 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": 901.08, "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": 901.08, "10th_percentile": 901.08, "90th_percentile": 901.08, "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": 858.1, "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": 858.1, "10th_percentile": 858.1, "90th_percentile": 858.1, "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": 952.67, "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": 952.67, "10th_percentile": 952.67, "90th_percentile": 952.67, "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": 1842.29, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1842.29, "10th_percentile": 1842.29, "90th_percentile": 1842.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2046.99, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2046.99, "10th_percentile": 2046.99, "90th_percentile": 2046.99, "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": 3684.57, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3684.57, "10th_percentile": 3684.57, "90th_percentile": 3684.57, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2616.05, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2616.05, "10th_percentile": 2616.05, "90th_percentile": 2616.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3357.06, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 3357.06, "10th_percentile": 3357.06, "90th_percentile": 3357.06, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1989.67, "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": 1989.67, "10th_percentile": 1989.67, "90th_percentile": 1989.67, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1940.54, "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": 1940.54, "10th_percentile": 1940.54, "90th_percentile": 1940.54, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4093.97, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2629.56, "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": 2629.56, "10th_percentile": 2629.56, "90th_percentile": 2629.56, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4093.97, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 859.73, "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": 859.73, "10th_percentile": 859.73, "90th_percentile": 859.73, "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 HMO/PPO", "standard_charge_dollar": 2157.52, "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": 2157.52, "10th_percentile": 2157.52, "90th_percentile": 2157.52, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "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": 4093.97, "10th_percentile": 4093.97, "90th_percentile": 4093.97, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ARTICULATION KT TOT ELB NEXEL SZ 4", "code_information": [ { "code": "SUP-159473", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 946.13, "maximum": 5699.59, "setting": "outpatient", "gross_charge": 5699.59, "discounted_cash": 3989.71, "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: $5,699.59 @ 12.8% = $729.55 due to $0.00 Claim Price", "median_amount": 729.55, "10th_percentile": 729.55, "90th_percentile": 729.55, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,699.59 @ 12.8% = $729.55 due to $0.00 Claim Price" }, { "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": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "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": 4559.67, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4559.67, "10th_percentile": 4559.67, "90th_percentile": 4559.67, "count": "0", "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": 1207.74, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1207.74, "10th_percentile": 1207.74, "90th_percentile": 1207.74, "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": 1555.99, "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": 1555.99, "10th_percentile": 1555.99, "90th_percentile": 1555.99, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5699.59, "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 $5,699.59 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "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 $5,699.59 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5699.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5699.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3003.68, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 3642.04, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3642.04, "10th_percentile": 3642.04, "90th_percentile": 3642.04, "count": "0", "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": 1196.91, "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": 1196.91, "10th_percentile": 1196.91, "90th_percentile": 1196.91, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3660.85, "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": 3660.85, "10th_percentile": 3660.85, "90th_percentile": 3660.85, "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": 2701.61, "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": 2701.61, "10th_percentile": 2701.61, "90th_percentile": 2701.61, "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": 4388.68, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4388.68, "10th_percentile": 4388.68, "90th_percentile": 4388.68, "count": "0", "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": 5129.63, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5129.63, "10th_percentile": 5129.63, "90th_percentile": 5129.63, "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": 2849.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2849.8, "10th_percentile": 2849.8, "90th_percentile": 2849.8, "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 BROAD", "standard_charge_dollar": 2770.0, "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": 2770.0, "10th_percentile": 2770.0, "90th_percentile": 2770.0, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 1333.7, "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": 1333.7, "10th_percentile": 1333.7, "90th_percentile": 1333.7, "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 SELECT", "standard_charge_dollar": 1333.7, "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": 1333.7, "10th_percentile": 1333.7, "90th_percentile": 1333.7, "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": 1333.7, "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": 1333.7, "10th_percentile": 1333.7, "90th_percentile": 1333.7, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 946.13, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "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": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "count": "0", "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": 4559.67, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4559.67, "10th_percentile": 4559.67, "90th_percentile": 4559.67, "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": 1207.74, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1207.74, "10th_percentile": 1207.74, "90th_percentile": 1207.74, "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": 1555.99, "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": 1555.99, "10th_percentile": 1555.99, "90th_percentile": 1555.99, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5699.59, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 5699.59, "10th_percentile": 5699.59, "90th_percentile": 5699.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2593.31, "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": 2593.31, "10th_percentile": 2593.31, "90th_percentile": 2593.31, "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": 2450.82, "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": 2450.82, "10th_percentile": 2450.82, "90th_percentile": 2450.82, "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." } ] } ] }, { "description": "ASSEMBLY FMRL SZ6 LGN HK RGHT", "code_information": [ { "code": "SUP-445447", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 15967.83, "maximum": 96191.72, "setting": "outpatient", "gross_charge": 96191.72, "discounted_cash": 67334.2, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 15967.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $96,191.72 @ 12.8% = $12,312.54 due to $0.00 Claim Price", "median_amount": 12312.54, "10th_percentile": 12312.54, "90th_percentile": 12312.54, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $96,191.72 @ 12.8% = $12,312.54 due to $0.00 Claim Price" }, { "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": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "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": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "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": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 20383.03, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 20383.03, "10th_percentile": 20383.03, "90th_percentile": 20383.03, "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 HMO", "standard_charge_dollar": 20383.03, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 20383.03, "10th_percentile": 20383.03, "90th_percentile": 20383.03, "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": 26260.34, "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": 26260.34, "10th_percentile": 26260.34, "90th_percentile": 26260.34, "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": 26260.34, "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": 26260.34, "10th_percentile": 26260.34, "90th_percentile": 26260.34, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 96191.72, "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 $96,191.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "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 $96,191.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 96191.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 96191.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 61466.51, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 61466.51, "10th_percentile": 61466.51, "90th_percentile": 61466.51, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 68777.08, "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Stop Loss; 71.5% Billed", "median_amount": 68777.08, "10th_percentile": 68777.08, "90th_percentile": 68777.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Stop Loss; 71.5% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 20200.26, "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": 20200.26, "10th_percentile": 20200.26, "90th_percentile": 20200.26, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 43767.23, "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": 43767.23, "10th_percentile": 43767.23, "90th_percentile": 43767.23, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 74067.62, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 74067.62, "10th_percentile": 74067.62, "90th_percentile": 74067.62, "count": "0", "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": 86572.55, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 86572.55, "10th_percentile": 86572.55, "90th_percentile": 86572.55, "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": 48095.86, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 48095.86, "10th_percentile": 48095.86, "90th_percentile": 48095.86, "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 BROAD", "standard_charge_dollar": 46749.18, "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": 46749.18, "10th_percentile": 46749.18, "90th_percentile": 46749.18, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 41362.44, "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": 41362.44, "10th_percentile": 41362.44, "90th_percentile": 41362.44, "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 OPTIONS", "standard_charge_dollar": 22508.86, "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": 22508.86, "10th_percentile": 22508.86, "90th_percentile": 22508.86, "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 SELECT", "standard_charge_dollar": 22508.86, "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": 22508.86, "10th_percentile": 22508.86, "90th_percentile": 22508.86, "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": 22508.86, "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": 22508.86, "10th_percentile": 22508.86, "90th_percentile": 22508.86, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 96191.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 96191.72, "10th_percentile": 96191.72, "90th_percentile": 96191.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 50693.04, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 68777.08, "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Stop Loss; 71.5% Billed", "median_amount": 68777.08, "10th_percentile": 68777.08, "90th_percentile": 68777.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Stop Loss; 71.5% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 61783.94, "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": 61783.94, "10th_percentile": 61783.94, "90th_percentile": 61783.94, "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": 45594.88, "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": 45594.88, "10th_percentile": 45594.88, "90th_percentile": 45594.88, "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." } ] } ] }, { "description": "ASSEMBLY INNR WR ILC PRB CNNLTD LNG", "code_information": [ { "code": "SUP-434507", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1601.15, "maximum": 9645.46, "setting": "outpatient", "gross_charge": 9645.46, "discounted_cash": 6751.82, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 7716.37, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 7716.37, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 2043.87, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2043.87, "10th_percentile": 2043.87, "90th_percentile": 2043.87, "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 HMO", "standard_charge_dollar": 2043.87, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2043.87, "10th_percentile": 2043.87, "90th_percentile": 2043.87, "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": 2634.18, "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": 2634.18, "10th_percentile": 2634.18, "90th_percentile": 2634.18, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2634.18, "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": 2634.18, "10th_percentile": 2634.18, "90th_percentile": 2634.18, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 9645.46, "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 $9,645.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "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 $9,645.46 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 BLUECHOICE PREFERRED", "standard_charge_dollar": 2122.97, "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": 2122.97, "10th_percentile": 2122.97, "90th_percentile": 2122.97, "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": 2021.69, "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": 2021.69, "10th_percentile": 2021.69, "90th_percentile": 2021.69, "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": 2244.5, "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": 2244.5, "10th_percentile": 2244.5, "90th_percentile": 2244.5, "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": 4340.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 4340.46, "10th_percentile": 4340.46, "90th_percentile": 4340.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 4822.73, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4822.73, "10th_percentile": 4822.73, "90th_percentile": 4822.73, "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", "standard_charge_dollar": 4147.55, "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": 4147.55, "10th_percentile": 4147.55, "90th_percentile": 4147.55, "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": 1601.15, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1601.15, "10th_percentile": 1601.15, "90th_percentile": 1601.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 8680.91, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 8680.91, "10th_percentile": 8680.91, "90th_percentile": 8680.91, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6163.45, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6163.45, "10th_percentile": 6163.45, "90th_percentile": 6163.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 7909.28, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 7909.28, "10th_percentile": 7909.28, "90th_percentile": 7909.28, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 4687.69, "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": 4687.69, "10th_percentile": 4687.69, "90th_percentile": 4687.69, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 4571.95, "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": 4571.95, "10th_percentile": 4571.95, "90th_percentile": 4571.95, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9645.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 6195.28, "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": 6195.28, "10th_percentile": 6195.28, "90th_percentile": 6195.28, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 9645.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2025.55, "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": 2025.55, "10th_percentile": 2025.55, "90th_percentile": 2025.55, "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 ASA", "standard_charge_dollar": 4388.68, "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": 4388.68, "10th_percentile": 4388.68, "90th_percentile": 4388.68, "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": 5083.16, "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": 5083.16, "10th_percentile": 5083.16, "90th_percentile": 5083.16, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "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": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "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": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "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": 9645.46, "10th_percentile": 9645.46, "90th_percentile": 9645.46, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ATAZANAVIR 200 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-36150", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "31722-0654-60", "type": "NDC" } ], "standard_charges": [ { "minimum": 3.65, "maximum": 22.0, "setting": "outpatient", "gross_charge": 22.0, "discounted_cash": 15.4, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 6.01, "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": 6.01, "10th_percentile": 6.01, "90th_percentile": 6.01, "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 PPO", "standard_charge_dollar": 6.01, "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": 6.01, "10th_percentile": 6.01, "90th_percentile": 6.01, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 4.66, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4.66, "10th_percentile": 4.66, "90th_percentile": 4.66, "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 HMO", "standard_charge_dollar": 4.66, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4.66, "10th_percentile": 4.66, "90th_percentile": 4.66, "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": 17.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 17.6, "10th_percentile": 17.6, "90th_percentile": 17.6, "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": 17.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 17.6, "10th_percentile": 17.6, "90th_percentile": 17.6, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 22.0, "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 $22.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "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 $22.00 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": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 9.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 9.9, "10th_percentile": 9.9, "90th_percentile": 9.9, "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": 4.61, "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": 4.61, "10th_percentile": 4.61, "90th_percentile": 4.61, "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 PREFERRED", "standard_charge_dollar": 4.84, "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": 4.84, "10th_percentile": 4.84, "90th_percentile": 4.84, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5.12, "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": 5.12, "10th_percentile": 5.12, "90th_percentile": 5.12, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 3.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3.65, "10th_percentile": 3.65, "90th_percentile": 3.65, "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 ALTERNATIVE", "standard_charge_dollar": 4.62, "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": 4.62, "10th_percentile": 4.62, "90th_percentile": 4.62, "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 ASA", "standard_charge_dollar": 10.01, "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": 10.01, "10th_percentile": 10.01, "90th_percentile": 10.01, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 18.04, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 18.04, "10th_percentile": 18.04, "90th_percentile": 18.04, "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", "standard_charge_dollar": 9.46, "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": 9.46, "10th_percentile": 9.46, "90th_percentile": 9.46, "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": 11.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 11.0, "10th_percentile": 11.0, "90th_percentile": 11.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 22.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 10.69, "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": 10.69, "10th_percentile": 10.69, "90th_percentile": 10.69, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 22.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 22.0, "10th_percentile": 22.0, "90th_percentile": 22.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 19.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 19.8, "10th_percentile": 19.8, "90th_percentile": 19.8, "count": "0", "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": 11.59, "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": 11.59, "10th_percentile": 11.59, "90th_percentile": 11.59, "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": 14.13, "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": 14.13, "10th_percentile": 14.13, "90th_percentile": 14.13, "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": 10.43, "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": 10.43, "10th_percentile": 10.43, "90th_percentile": 10.43, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 14.06, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 14.06, "10th_percentile": 14.06, "90th_percentile": 14.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" } ] } ] }, { "description": "ATENOLOL 25 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-717", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "60687-0605-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.33, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.0, "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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "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 $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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "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: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 0.95, "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": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1.05, "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": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "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": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 1.8, "90th_percentile": 1.8, "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": 1.64, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 1.64, "10th_percentile": 1.64, "90th_percentile": 1.64, "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 $19,355 CASE RATE" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.33, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.33, "10th_percentile": 0.33, "90th_percentile": 0.33, "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 ASA", "standard_charge_dollar": 0.91, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 0.91, "10th_percentile": 0.91, "90th_percentile": 0.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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": 0.86, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "Drugs/Agents Default; 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": 0.86, "10th_percentile": 0.86, "90th_percentile": 0.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1.28, "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": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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 SELECT", "standard_charge_dollar": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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." } ] } ] }, { "description": "ATENOLOL 25 MG ORAL TAB", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-717", "type": "CDM" }, { "code": "J3490", "type": "HCPCS" }, { "code": "0637", "type": "RC" }, { "code": "60687-0605-11", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.33, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 2.0, "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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "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 $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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "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: $2.00 @ 12.8% = $0.26 due to $0.00 Claim Price", "median_amount": 0.26, "10th_percentile": 0.26, "90th_percentile": 0.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 0.95, "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": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1.05, "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": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "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": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 1.8, "90th_percentile": 1.8, "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": 1.64, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 1.64, "10th_percentile": 1.64, "90th_percentile": 1.64, "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 $19,355 CASE RATE" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.33, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.33, "10th_percentile": 0.33, "90th_percentile": 0.33, "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 ASA", "standard_charge_dollar": 0.91, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 0.91, "10th_percentile": 0.91, "90th_percentile": 0.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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": 0.86, "standard_charge_percentage": 43.0, "standard_charge_algorithm": "Drugs/Agents Default; 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": 0.86, "10th_percentile": 0.86, "90th_percentile": 0.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents Default; 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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1.28, "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": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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 SELECT", "standard_charge_dollar": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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." } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2011.0, "maximum": 11863.8, "setting": "inpatient", "gross_charge": 39968.0, "discounted_cash": 27977.6, "payers_information": [ { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 9968.75, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; DRG Base Rate; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 14,808.00, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR 79.05% OF CHARGES; Note: Paid contractual rate, which is the lesser of contractual rate and 79.05% of charges.", "median_amount": 17984.44, "10th_percentile": 17984.44, "90th_percentile": 17984.44, "count": "12", "methodology": "case rate" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 10677.63, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; DRG Base Rate; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 15,861.00, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14695.8, "10th_percentile": 14695.8, "90th_percentile": 14695.8, "count": "12", "methodology": "case rate" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 11863.8, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; DRG Base Rate; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 17,623.00, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 16325.97, "10th_percentile": 16325.97, "90th_percentile": 16325.97, "count": "12", "methodology": "case rate" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2011.0, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; Med Surg; Per Diem @ $2,011.00, and; Pricing Extension - NM HB Lesser of Total Billed or 71.5% of Charges; Note: Paid at contractual rate, which is the lesser of contractual and 71.5% of charges. Total pmt for all lines paid so far is less than 71.5% of claim billed amount.", "median_amount": 15866.6, "10th_percentile": 15866.6, "90th_percentile": 15866.6, "count": "12", "methodology": "per diem" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 39968.0, "10th_percentile": 39968.0, "90th_percentile": 39968.0, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services - OON; 100% Billed", "median_amount": 27456.25, "10th_percentile": 27456.25, "90th_percentile": 27456.25, "count": "12", "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 drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 34713.09, "10th_percentile": 34713.09, "90th_percentile": 34713.09, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 65.0, "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "median_amount": 25816.33, "10th_percentile": 25816.33, "90th_percentile": 25816.33, "count": "12", "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, and other services can be included in reimbursement.", "median_amount": 19984.01, "10th_percentile": 19984.01, "90th_percentile": 19984.01, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2011.0, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; Med Surg; Per Diem @ $2,011.00, and; Pricing Extension - NM HB Lesser of Total Billed or 71.5% of Charges; Note: Paid at contractual rate, which is the lesser of contractual and 71.5% of charges. Total pmt for all lines paid so far is less than 71.5% of claim billed amount.", "median_amount": 15866.6, "10th_percentile": 15866.6, "90th_percentile": 15866.6, "count": "12", "methodology": "per diem" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 6430.41, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; IP DRG Base Rate; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 9,552.00, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 9537.06, "10th_percentile": 9537.06, "90th_percentile": 9537.06, "count": "12", "methodology": "case rate" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 8038.01, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; IP DRG Base Rate; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 11,940.00, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14816.31, "10th_percentile": 14816.31, "90th_percentile": 14816.31, "count": "12", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 7450.98, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25204.75, "10th_percentile": 25204.75, "90th_percentile": 25204.75, "count": "12", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 9791.69, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13561.94, "10th_percentile": 13561.94, "90th_percentile": 13561.94, "count": "12", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8386.73, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 12,458.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE STOP LOSS & LESSOR OF 9*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11832.01, "10th_percentile": 11832.01, "90th_percentile": 11832.01, "count": "12", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 7994.92, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 11,876.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE PREF STOP LOSS & LESSOR*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11253.67, "10th_percentile": 11253.67, "90th_percentile": 11253.67, "count": "12", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 7838.07, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 11,643.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE SELECT STOP LOSS & LESS*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10941.33, "10th_percentile": 10941.33, "90th_percentile": 10941.33, "count": "12", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 7450.98, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 25204.75, "10th_percentile": 25204.75, "90th_percentile": 25204.75, "count": "12", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 9791.69, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.6732, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 13561.94, "10th_percentile": 13561.94, "90th_percentile": 13561.94, "count": "12", "methodology": "case rate" }, { "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, radiology services, and other services can be included in reimbursement.", "median_amount": 39968.0, "10th_percentile": 39968.0, "90th_percentile": 39968.0, "count": "12", "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, radiology services, and other services can be included in reimbursement.", "median_amount": 30257.54, "10th_percentile": 30257.54, "90th_percentile": 30257.54, "count": "12", "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, radiology services, and other services can be included in reimbursement.", "median_amount": 11164.59, "10th_percentile": 11164.59, "90th_percentile": 11164.59, "count": "12", "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, and other services can be included in reimbursement.", "median_amount": 22455.07, "10th_percentile": 22455.07, "90th_percentile": 22455.07, "count": "12", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_dollar": 4829.08, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,169.00; Total: $6,169.00", "median_amount": 6863.44, "10th_percentile": 6863.44, "90th_percentile": 6863.44, "count": "12", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,169.00; Total: $6,169.00" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 4829.08, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,169.00; Total: $6,169.00", "median_amount": 6863.44, "10th_percentile": 6863.44, "90th_percentile": 6863.44, "count": "12", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,169.00; Total: $6,169.00" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_dollar": 4829.08, "standard_charge_algorithm": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $5,233.05; Total: $5,233.05 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5927.49, "10th_percentile": 5927.49, "90th_percentile": 5927.49, "count": "12", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.769349540; Using historical claim(s); Scope: All Financial Classes; Cases: 12; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.67, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $5,233.05; Total: $5,233.05 Paid at contractual rate, which is 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": "ATL STAPLE CAUDAL TI", "code_information": [ { "code": "SUP-306208", "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": "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed 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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": 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": 779.7, "10th_percentile": 779.7, "90th_percentile": 779.7, "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": "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": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 2665.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2665.66, "10th_percentile": 2665.66, "90th_percentile": 2665.66, "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": 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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": "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": 909.66, "10th_percentile": 909.66, "90th_percentile": 909.66, "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": "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": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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": 706.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 706.07, "10th_percentile": 706.07, "90th_percentile": 706.07, "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 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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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 $3,332.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3332.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "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": 2565.69, "10th_percentile": 2565.69, "90th_percentile": 2565.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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": 2129.19, "10th_percentile": 2129.19, "90th_percentile": 2129.19, "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": 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": 1432.79, "10th_percentile": 1432.79, "90th_percentile": 1432.79, "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": "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": 1666.04, "10th_percentile": 1666.04, "90th_percentile": 1666.04, "count": "0", "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": 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": 2140.19, "10th_percentile": 2140.19, "90th_percentile": 2140.19, "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": "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": 1516.09, "10th_percentile": 1516.09, "90th_percentile": 1516.09, "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": "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": 2998.86, "10th_percentile": 2998.86, "90th_percentile": 2998.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% 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": 1579.4, "10th_percentile": 1579.4, "90th_percentile": 1579.4, "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": 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": 699.73, "10th_percentile": 699.73, "90th_percentile": 699.73, "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": "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": 426.5, "10th_percentile": 426.5, "90th_percentile": 426.5, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 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 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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "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": 3332.07, "10th_percentile": 3332.07, "90th_percentile": 3332.07, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ATROPINE 0.1 MG/ML INJ SYRG", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "RX-730", "type": "CDM" }, { "code": "J0461", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "00409-1630-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 11.83, "maximum": 71.25, "setting": "outpatient", "gross_charge": 71.25, "discounted_cash": 49.87, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 16.67, "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": 16.67, "10th_percentile": 16.67, "90th_percentile": 16.67, "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": 16.67, "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": 16.67, "10th_percentile": 16.67, "90th_percentile": 16.67, "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 SELECT", "standard_charge_dollar": 16.67, "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": 16.67, "10th_percentile": 16.67, "90th_percentile": 16.67, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 57.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 57.0, "10th_percentile": 57.0, "90th_percentile": 57.0, "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": 57.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 57.0, "10th_percentile": 57.0, "90th_percentile": 57.0, "count": "0", "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": 15.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 15.1, "10th_percentile": 15.1, "90th_percentile": 15.1, "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": 15.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 15.1, "10th_percentile": 15.1, "90th_percentile": 15.1, "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": 19.45, "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": 19.45, "10th_percentile": 19.45, "90th_percentile": 19.45, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 19.45, "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": 19.45, "10th_percentile": 19.45, "90th_percentile": 19.45, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 71.25, "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 $71.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 71.25, "10th_percentile": 71.25, "90th_percentile": 71.25, "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 $71.25 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 71.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 71.25, "10th_percentile": 71.25, "90th_percentile": 71.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 71.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 71.25, "10th_percentile": 71.25, "90th_percentile": 71.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 64.13, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 64.13, "10th_percentile": 64.13, "90th_percentile": 64.13, "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": 35.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 35.63, "10th_percentile": 35.63, "90th_percentile": 35.63, "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 ASA", "standard_charge_dollar": 32.42, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 32.42, "10th_percentile": 32.42, "90th_percentile": 32.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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 PLATINUM/CHC ELITE", "standard_charge_dollar": 45.53, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 45.53, "10th_percentile": 45.53, "90th_percentile": 45.53, "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 NM EMPLOYEES", "standard_charge_dollar": 11.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 11.83, "10th_percentile": 11.83, "90th_percentile": 11.83, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 32.06, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 32.06, "10th_percentile": 32.06, "90th_percentile": 32.06, "count": "0", "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": 58.43, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP; 82% Billed", "median_amount": 58.43, "10th_percentile": 58.43, "90th_percentile": 58.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP; 82% 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: $71.25 @ 12.8% = $9.12 due to $0.00 Claim Price", "median_amount": 9.12, "10th_percentile": 9.12, "90th_percentile": 9.12, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $71.25 @ 12.8% = $9.12 due to $0.00 Claim Price" }, { "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": 71.25, "10th_percentile": 71.25, "90th_percentile": 71.25, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 71.25, "10th_percentile": 71.25, "90th_percentile": 71.25, "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": 71.25, "10th_percentile": 71.25, "90th_percentile": 71.25, "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": 71.25, "10th_percentile": 71.25, "90th_percentile": 71.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "ATTAIN COMMAND EXTENDED HOOK", "code_information": [ { "code": "SUP-148243", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 291.12, "maximum": 1753.72, "setting": "outpatient", "gross_charge": 1753.72, "discounted_cash": 1227.6, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 924.21, "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": 97.53, "10th_percentile": 97.53, "90th_percentile": 97.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $1,753.72 @ 12.8% = $224.48 due to $0.00 Claim Price", "median_amount": 224.48, "10th_percentile": 224.48, "90th_percentile": 224.48, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $1,753.72 @ 12.8% = $224.48 due to $0.00 Claim Price" }, { "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": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "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": 754.1, "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": 754.1, "10th_percentile": 754.1, "90th_percentile": 754.1, "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 BROAD", "standard_charge_dollar": 852.31, "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": 105.27, "10th_percentile": 105.27, "90th_percentile": 105.27, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1578.35, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1578.35, "10th_percentile": 1578.35, "90th_percentile": 1578.35, "count": "0", "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": 368.28, "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": 368.28, "10th_percentile": 368.28, "90th_percentile": 368.28, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1126.41, "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": 1126.41, "10th_percentile": 1126.41, "90th_percentile": 1126.41, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 876.86, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 876.86, "10th_percentile": 876.86, "90th_percentile": 876.86, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 1120.63, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1120.63, "10th_percentile": 1120.63, "90th_percentile": 1120.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1438.05, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 1438.05, "10th_percentile": 1438.05, "90th_percentile": 1438.05, "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 $19,355 CASE RATE" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 291.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 291.12, "10th_percentile": 291.12, "90th_percentile": 291.12, "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 ASA", "standard_charge_dollar": 797.94, "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": 797.94, "10th_percentile": 797.94, "90th_percentile": 797.94, "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 CORE", "standard_charge_dollar": 831.26, "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": 831.26, "10th_percentile": 831.26, "90th_percentile": 831.26, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 789.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1753.72, "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 $1,753.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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 $1,753.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1753.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1753.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1402.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1402.98, "10th_percentile": 1402.98, "90th_percentile": 1402.98, "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": 1402.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1402.98, "10th_percentile": 1402.98, "90th_percentile": 1402.98, "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": 371.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 371.61, "10th_percentile": 371.61, "90th_percentile": 371.61, "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 HMO", "standard_charge_dollar": 371.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 371.61, "10th_percentile": 371.61, "90th_percentile": 371.61, "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": 478.77, "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": 478.77, "10th_percentile": 478.77, "90th_percentile": 478.77, "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": 478.77, "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": 478.77, "10th_percentile": 478.77, "90th_percentile": 478.77, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 410.37, "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": 410.37, "10th_percentile": 410.37, "90th_percentile": 410.37, "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": 410.37, "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": 410.37, "10th_percentile": 410.37, "90th_percentile": 410.37, "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 SELECT", "standard_charge_dollar": 410.37, "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": 410.37, "10th_percentile": 410.37, "90th_percentile": 410.37, "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." } ] } ] }, { "description": "AUG TIB 360 75X15MM RL/LM", "code_information": [ { "code": "SUP-375606", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1216.87, "maximum": 7330.55, "setting": "outpatient", "gross_charge": 7330.55, "discounted_cash": 5131.38, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1216.87, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,330.55 @ 12.8% = $938.31 due to $0.00 Claim Price", "median_amount": 938.31, "10th_percentile": 938.31, "90th_percentile": 938.31, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,330.55 @ 12.8% = $938.31 due to $0.00 Claim Price" }, { "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": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "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": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "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": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "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 PPO", "standard_charge_dollar": 2001.24, "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": 2001.24, "10th_percentile": 2001.24, "90th_percentile": 2001.24, "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": 2001.24, "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": 2001.24, "10th_percentile": 2001.24, "90th_percentile": 2001.24, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 5864.44, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5864.44, "10th_percentile": 5864.44, "90th_percentile": 5864.44, "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": 5864.44, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5864.44, "10th_percentile": 5864.44, "90th_percentile": 5864.44, "count": "0", "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": 1553.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1553.34, "10th_percentile": 1553.34, "90th_percentile": 1553.34, "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": 1553.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1553.34, "10th_percentile": 1553.34, "90th_percentile": 1553.34, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 7330.55, "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 $7,330.55 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "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 $7,330.55 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7330.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7330.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7330.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7330.55, "10th_percentile": 7330.55, "90th_percentile": 7330.55, "count": "0", "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": 3863.2, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3474.68, "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": 3474.68, "10th_percentile": 3474.68, "90th_percentile": 3474.68, "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": 5644.52, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5644.52, "10th_percentile": 5644.52, "90th_percentile": 5644.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1539.42, "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": 1539.42, "10th_percentile": 1539.42, "90th_percentile": 1539.42, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6597.5, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6597.5, "10th_percentile": 6597.5, "90th_percentile": 6597.5, "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": 3335.4, "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": 3335.4, "10th_percentile": 3335.4, "90th_percentile": 3335.4, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4708.41, "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": 4708.41, "10th_percentile": 4708.41, "90th_percentile": 4708.41, "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 BROAD", "standard_charge_dollar": 3562.65, "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": 3562.65, "10th_percentile": 3562.65, "90th_percentile": 3562.65, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4684.22, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4684.22, "10th_percentile": 4684.22, "90th_percentile": 4684.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3665.28, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3665.28, "10th_percentile": 3665.28, "90th_percentile": 3665.28, "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", "standard_charge_dollar": 3152.14, "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": 3152.14, "10th_percentile": 3152.14, "90th_percentile": 3152.14, "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": 1715.35, "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": 1715.35, "10th_percentile": 1715.35, "90th_percentile": 1715.35, "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": 1715.35, "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": 1715.35, "10th_percentile": 1715.35, "90th_percentile": 1715.35, "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 SELECT", "standard_charge_dollar": 1715.35, "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": 1715.35, "10th_percentile": 1715.35, "90th_percentile": 1715.35, "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." } ] } ] }, { "description": "AUG TIB BMT 360 63X5MM", "code_information": [ { "code": "SUP-313974", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1262.08, "maximum": 7602.92, "setting": "outpatient", "gross_charge": 7602.92, "discounted_cash": 5322.04, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1262.08, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,602.92 @ 12.8% = $973.17 due to $0.00 Claim Price", "median_amount": 973.17, "10th_percentile": 973.17, "90th_percentile": 973.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,602.92 @ 12.8% = $973.17 due to $0.00 Claim Price" }, { "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": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "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": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "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": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "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 BCBS PPO", "standard_charge_dollar": 2075.6, "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": 2075.6, "10th_percentile": 2075.6, "90th_percentile": 2075.6, "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": 2075.6, "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": 2075.6, "10th_percentile": 2075.6, "90th_percentile": 2075.6, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6082.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6082.34, "10th_percentile": 6082.34, "90th_percentile": 6082.34, "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": 6082.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6082.34, "10th_percentile": 6082.34, "90th_percentile": 6082.34, "count": "0", "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": 1611.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1611.06, "10th_percentile": 1611.06, "90th_percentile": 1611.06, "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": 1611.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1611.06, "10th_percentile": 1611.06, "90th_percentile": 1611.06, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 7602.92, "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 $7,602.92 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "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 $7,602.92 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7602.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7602.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7602.92, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7602.92, "10th_percentile": 7602.92, "90th_percentile": 7602.92, "count": "0", "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": 4006.74, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3603.78, "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": 3603.78, "10th_percentile": 3603.78, "90th_percentile": 3603.78, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5854.25, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5854.25, "10th_percentile": 5854.25, "90th_percentile": 5854.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1596.61, "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": 1596.61, "10th_percentile": 1596.61, "90th_percentile": 1596.61, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6842.63, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6842.63, "10th_percentile": 6842.63, "90th_percentile": 6842.63, "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": 3459.33, "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": 3459.33, "10th_percentile": 3459.33, "90th_percentile": 3459.33, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4883.36, "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": 4883.36, "10th_percentile": 4883.36, "90th_percentile": 4883.36, "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 BROAD", "standard_charge_dollar": 3695.02, "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": 3695.02, "10th_percentile": 3695.02, "90th_percentile": 3695.02, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4858.27, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4858.27, "10th_percentile": 4858.27, "90th_percentile": 4858.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3801.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3801.46, "10th_percentile": 3801.46, "90th_percentile": 3801.46, "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", "standard_charge_dollar": 3269.26, "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": 3269.26, "10th_percentile": 3269.26, "90th_percentile": 3269.26, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1779.08, "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": 1779.08, "10th_percentile": 1779.08, "90th_percentile": 1779.08, "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": 1779.08, "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": 1779.08, "10th_percentile": 1779.08, "90th_percentile": 1779.08, "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 SELECT", "standard_charge_dollar": 1779.08, "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": 1779.08, "10th_percentile": 1779.08, "90th_percentile": 1779.08, "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." } ] } ] }, { "description": "AUGMENT BLOCK 5MM SZ 4 POSTERIOR 02-010-06-0541", "code_information": [ { "code": "SUP-344729", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1496.23, "maximum": 9013.46, "setting": "outpatient", "gross_charge": 9013.46, "discounted_cash": 6309.42, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1496.23, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $9,013.46 @ 12.8% = $1,153.72 due to $0.00 Claim Price", "median_amount": 1153.72, "10th_percentile": 1153.72, "90th_percentile": 1153.72, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $9,013.46 @ 12.8% = $1,153.72 due to $0.00 Claim Price" }, { "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": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "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": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "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": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "count": "0", "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": 7210.77, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7210.77, "10th_percentile": 7210.77, "90th_percentile": 7210.77, "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": 7210.77, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7210.77, "10th_percentile": 7210.77, "90th_percentile": 7210.77, "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": 1909.95, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1909.95, "10th_percentile": 1909.95, "90th_percentile": 1909.95, "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 HMO", "standard_charge_dollar": 1909.95, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1909.95, "10th_percentile": 1909.95, "90th_percentile": 1909.95, "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": 2460.67, "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": 2460.67, "10th_percentile": 2460.67, "90th_percentile": 2460.67, "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": 2460.67, "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": 2460.67, "10th_percentile": 2460.67, "90th_percentile": 2460.67, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 9013.46, "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 $9,013.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "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 $9,013.46 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9013.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 9013.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 9013.46, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 9013.46, "10th_percentile": 9013.46, "90th_percentile": 9013.46, "count": "0", "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": 4750.09, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 5759.6, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 5759.6, "10th_percentile": 5759.6, "90th_percentile": 5759.6, "count": "0", "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": 1892.83, "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": 1892.83, "10th_percentile": 1892.83, "90th_percentile": 1892.83, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 5789.35, "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": 5789.35, "10th_percentile": 5789.35, "90th_percentile": 5789.35, "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": 4272.38, "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": 4272.38, "10th_percentile": 4272.38, "90th_percentile": 4272.38, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 4101.12, "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": 4101.12, "10th_percentile": 4101.12, "90th_percentile": 4101.12, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 6940.36, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 6940.36, "10th_percentile": 6940.36, "90th_percentile": 6940.36, "count": "0", "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": 8112.11, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 8112.11, "10th_percentile": 8112.11, "90th_percentile": 8112.11, "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": 4506.73, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4506.73, "10th_percentile": 4506.73, "90th_percentile": 4506.73, "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 BROAD", "standard_charge_dollar": 4380.54, "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": 4380.54, "10th_percentile": 4380.54, "90th_percentile": 4380.54, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3875.79, "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": 3875.79, "10th_percentile": 3875.79, "90th_percentile": 3875.79, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2109.15, "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": 2109.15, "10th_percentile": 2109.15, "90th_percentile": 2109.15, "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 SELECT", "standard_charge_dollar": 2109.15, "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": 2109.15, "10th_percentile": 2109.15, "90th_percentile": 2109.15, "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": 2109.15, "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": 2109.15, "10th_percentile": 2109.15, "90th_percentile": 2109.15, "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." } ] } ] }, { "description": "AUGMENT FEM 10MM SZ 9 DISTAL PSN REV 42556606610", "code_information": [ { "code": "SUP-345960", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1280.92, "maximum": 7716.37, "setting": "outpatient", "gross_charge": 7716.37, "discounted_cash": 5401.46, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1280.92, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,716.37 @ 12.8% = $987.70 due to $0.00 Claim Price", "median_amount": 987.7, "10th_percentile": 987.7, "90th_percentile": 987.7, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,716.37 @ 12.8% = $987.70 due to $0.00 Claim Price" }, { "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 6173.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6173.1, "10th_percentile": 6173.1, "90th_percentile": 6173.1, "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": 6173.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6173.1, "10th_percentile": 6173.1, "90th_percentile": 6173.1, "count": "0", "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": 1635.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1635.1, "10th_percentile": 1635.1, "90th_percentile": 1635.1, "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": 1635.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1635.1, "10th_percentile": 1635.1, "90th_percentile": 1635.1, "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": 2106.57, "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": 2106.57, "10th_percentile": 2106.57, "90th_percentile": 2106.57, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2106.57, "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": 2106.57, "10th_percentile": 2106.57, "90th_percentile": 2106.57, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7716.37, "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 $7,716.37 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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 $7,716.37 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": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4066.53, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1620.44, "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": 1620.44, "10th_percentile": 1620.44, "90th_percentile": 1620.44, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6944.73, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6944.73, "10th_percentile": 6944.73, "90th_percentile": 6944.73, "count": "0", "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": 3750.16, "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": 3750.16, "10th_percentile": 3750.16, "90th_percentile": 3750.16, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3510.95, "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": 3510.95, "10th_percentile": 3510.95, "90th_percentile": 3510.95, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4930.76, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4930.76, "10th_percentile": 4930.76, "90th_percentile": 4930.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3858.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3858.19, "10th_percentile": 3858.19, "90th_percentile": 3858.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5941.6, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5941.6, "10th_percentile": 5941.6, "90th_percentile": 5941.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3318.04, "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": 3318.04, "10th_percentile": 3318.04, "90th_percentile": 3318.04, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4956.22, "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": 4956.22, "10th_percentile": 4956.22, "90th_percentile": 4956.22, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3657.56, "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": 3657.56, "10th_percentile": 3657.56, "90th_percentile": 3657.56, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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 SELECT", "standard_charge_dollar": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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." } ] } ] }, { "description": "AUGMENT FEM 10MM SZ11 DISTAL PERSONA", "code_information": [ { "code": "SUP-421168", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1280.92, "maximum": 7716.37, "setting": "outpatient", "gross_charge": 7716.37, "discounted_cash": 5401.46, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1280.92, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,716.37 @ 12.8% = $987.70 due to $0.00 Claim Price", "median_amount": 987.7, "10th_percentile": 987.7, "90th_percentile": 987.7, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,716.37 @ 12.8% = $987.70 due to $0.00 Claim Price" }, { "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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 PPO", "standard_charge_dollar": 2106.57, "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": 2106.57, "10th_percentile": 2106.57, "90th_percentile": 2106.57, "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": 2106.57, "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": 2106.57, "10th_percentile": 2106.57, "90th_percentile": 2106.57, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6173.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6173.1, "10th_percentile": 6173.1, "90th_percentile": 6173.1, "count": "0", "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": 1635.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1635.1, "10th_percentile": 1635.1, "90th_percentile": 1635.1, "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": 1635.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1635.1, "10th_percentile": 1635.1, "90th_percentile": 1635.1, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 7716.37, "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 $7,716.37 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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 $7,716.37 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": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5941.6, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5941.6, "10th_percentile": 5941.6, "90th_percentile": 5941.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1620.44, "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": 1620.44, "10th_percentile": 1620.44, "90th_percentile": 1620.44, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6944.73, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6944.73, "10th_percentile": 6944.73, "90th_percentile": 6944.73, "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": 3510.95, "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": 3510.95, "10th_percentile": 3510.95, "90th_percentile": 3510.95, "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 BROAD", "standard_charge_dollar": 3750.16, "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": 3750.16, "10th_percentile": 3750.16, "90th_percentile": 3750.16, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4930.76, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4930.76, "10th_percentile": 4930.76, "90th_percentile": 4930.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3858.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3858.19, "10th_percentile": 3858.19, "90th_percentile": 3858.19, "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", "standard_charge_dollar": 3318.04, "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": 3318.04, "10th_percentile": 3318.04, "90th_percentile": 3318.04, "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": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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 SELECT", "standard_charge_dollar": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 6173.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6173.1, "10th_percentile": 6173.1, "90th_percentile": 6173.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4066.53, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 4956.22, "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": 4956.22, "10th_percentile": 4956.22, "90th_percentile": 4956.22, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3657.56, "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": 3657.56, "10th_percentile": 3657.56, "90th_percentile": 3657.56, "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." } ] } ] }, { "description": "AUGMENT FEM 8MM SZ2 STD RT DISTAL TI PFC SIGMA", "code_information": [ { "code": "SUP-377563", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1257.44, "maximum": 7574.93, "setting": "outpatient", "gross_charge": 7574.93, "discounted_cash": 5302.45, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1257.44, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,574.93 @ 12.8% = $969.59 due to $0.00 Claim Price", "median_amount": 969.59, "10th_percentile": 969.59, "90th_percentile": 969.59, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,574.93 @ 12.8% = $969.59 due to $0.00 Claim Price" }, { "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": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "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": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "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": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "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 PPO", "standard_charge_dollar": 2067.96, "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": 2067.96, "10th_percentile": 2067.96, "90th_percentile": 2067.96, "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": 2067.96, "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": 2067.96, "10th_percentile": 2067.96, "90th_percentile": 2067.96, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6059.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6059.94, "10th_percentile": 6059.94, "90th_percentile": 6059.94, "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": 6059.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6059.94, "10th_percentile": 6059.94, "90th_percentile": 6059.94, "count": "0", "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": 1605.13, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1605.13, "10th_percentile": 1605.13, "90th_percentile": 1605.13, "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": 1605.13, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1605.13, "10th_percentile": 1605.13, "90th_percentile": 1605.13, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 7574.93, "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 $7,574.93 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "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 $7,574.93 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7574.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7574.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7574.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7574.93, "10th_percentile": 7574.93, "90th_percentile": 7574.93, "count": "0", "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": 3991.99, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3590.52, "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": 3590.52, "10th_percentile": 3590.52, "90th_percentile": 3590.52, "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": 5832.7, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5832.7, "10th_percentile": 5832.7, "90th_percentile": 5832.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1590.74, "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": 1590.74, "10th_percentile": 1590.74, "90th_percentile": 1590.74, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6817.44, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6817.44, "10th_percentile": 6817.44, "90th_percentile": 6817.44, "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": 3446.59, "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": 3446.59, "10th_percentile": 3446.59, "90th_percentile": 3446.59, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4865.38, "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": 4865.38, "10th_percentile": 4865.38, "90th_percentile": 4865.38, "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 BROAD", "standard_charge_dollar": 3681.42, "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": 3681.42, "10th_percentile": 3681.42, "90th_percentile": 3681.42, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4840.38, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4840.38, "10th_percentile": 4840.38, "90th_percentile": 4840.38, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3787.47, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3787.47, "10th_percentile": 3787.47, "90th_percentile": 3787.47, "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", "standard_charge_dollar": 3257.22, "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": 3257.22, "10th_percentile": 3257.22, "90th_percentile": 3257.22, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 1772.53, "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": 1772.53, "10th_percentile": 1772.53, "90th_percentile": 1772.53, "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": 1772.53, "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": 1772.53, "10th_percentile": 1772.53, "90th_percentile": 1772.53, "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 SELECT", "standard_charge_dollar": 1772.53, "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": 1772.53, "10th_percentile": 1772.53, "90th_percentile": 1772.53, "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." } ] } ] }, { "description": "AUGMENT FEM SZ3-4 LT CENTRAL KN TRITANIUM CONE REV TRIATHLON", "code_information": [ { "code": "SUP-417228", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 14229.82, "maximum": 85721.83, "setting": "outpatient", "gross_charge": 85721.83, "discounted_cash": 60005.28, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 14229.82, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $85,721.83 @ 12.8% = $10,972.39 due to $0.00 Claim Price", "median_amount": 10972.39, "10th_percentile": 10972.39, "90th_percentile": 10972.39, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $85,721.83 @ 12.8% = $10,972.39 due to $0.00 Claim Price" }, { "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": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "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": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "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": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 18164.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 18164.46, "10th_percentile": 18164.46, "90th_percentile": 18164.46, "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 HMO", "standard_charge_dollar": 18164.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 18164.46, "10th_percentile": 18164.46, "90th_percentile": 18164.46, "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": 23402.06, "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": 23402.06, "10th_percentile": 23402.06, "90th_percentile": 23402.06, "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": 23402.06, "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": 23402.06, "10th_percentile": 23402.06, "90th_percentile": 23402.06, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 85721.83, "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 $85,721.83 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "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 $85,721.83 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 85721.83, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 85721.83, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 85721.83, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 85721.83, "10th_percentile": 85721.83, "90th_percentile": 85721.83, "count": "0", "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": 45175.4, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 54776.25, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 54776.25, "10th_percentile": 54776.25, "90th_percentile": 54776.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 61291.11, "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Stop Loss; 71.5% Billed", "median_amount": 61291.11, "10th_percentile": 61291.11, "90th_percentile": 61291.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Stop Loss; 71.5% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 61291.11, "standard_charge_percentage": 71.5, "standard_charge_algorithm": "Stop Loss; 71.5% Billed", "median_amount": 61291.11, "10th_percentile": 61291.11, "90th_percentile": 61291.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Stop Loss; 71.5% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 18001.58, "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": 18001.58, "10th_percentile": 18001.58, "90th_percentile": 18001.58, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 55059.13, "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": 55059.13, "10th_percentile": 55059.13, "90th_percentile": 55059.13, "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": 40632.15, "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": 40632.15, "10th_percentile": 40632.15, "90th_percentile": 40632.15, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 39003.43, "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": 39003.43, "10th_percentile": 39003.43, "90th_percentile": 39003.43, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 66005.81, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 66005.81, "10th_percentile": 66005.81, "90th_percentile": 66005.81, "count": "0", "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": 77149.65, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 77149.65, "10th_percentile": 77149.65, "90th_percentile": 77149.65, "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": 42860.92, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 42860.92, "10th_percentile": 42860.92, "90th_percentile": 42860.92, "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 BROAD", "standard_charge_dollar": 41660.81, "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": 41660.81, "10th_percentile": 41660.81, "90th_percentile": 41660.81, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 36860.39, "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": 36860.39, "10th_percentile": 36860.39, "90th_percentile": 36860.39, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 20058.91, "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": 20058.91, "10th_percentile": 20058.91, "90th_percentile": 20058.91, "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 SELECT", "standard_charge_dollar": 20058.91, "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": 20058.91, "10th_percentile": 20058.91, "90th_percentile": 20058.91, "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": 20058.91, "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": 20058.91, "10th_percentile": 20058.91, "90th_percentile": 20058.91, "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." } ] } ] }, { "description": "AUGMENT FMRL 2/12MM DSTL", "code_information": [ { "code": "SUP-433210", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1182.88, "maximum": 7125.8, "setting": "outpatient", "gross_charge": 7125.8, "discounted_cash": 4988.06, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1182.88, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,125.80 @ 12.8% = $912.10 due to $0.00 Claim Price", "median_amount": 912.1, "10th_percentile": 912.1, "90th_percentile": 912.1, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,125.80 @ 12.8% = $912.10 due to $0.00 Claim Price" }, { "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": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "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": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "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": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "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": 5700.64, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5700.64, "10th_percentile": 5700.64, "90th_percentile": 5700.64, "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": 5700.64, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5700.64, "10th_percentile": 5700.64, "90th_percentile": 5700.64, "count": "0", "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": 1509.96, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1509.96, "10th_percentile": 1509.96, "90th_percentile": 1509.96, "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": 1509.96, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1509.96, "10th_percentile": 1509.96, "90th_percentile": 1509.96, "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": 1945.34, "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": 1945.34, "10th_percentile": 1945.34, "90th_percentile": 1945.34, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1945.34, "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": 1945.34, "10th_percentile": 1945.34, "90th_percentile": 1945.34, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7125.8, "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 $7,125.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "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 $7,125.80 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": 7125.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7125.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7125.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7125.8, "10th_percentile": 7125.8, "90th_percentile": 7125.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3755.3, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1496.42, "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": 1496.42, "10th_percentile": 1496.42, "90th_percentile": 1496.42, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6413.22, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6413.22, "10th_percentile": 6413.22, "90th_percentile": 6413.22, "count": "0", "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": 3463.14, "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": 3463.14, "10th_percentile": 3463.14, "90th_percentile": 3463.14, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3242.24, "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": 3242.24, "10th_percentile": 3242.24, "90th_percentile": 3242.24, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4553.39, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4553.39, "10th_percentile": 4553.39, "90th_percentile": 4553.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3562.9, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3562.9, "10th_percentile": 3562.9, "90th_percentile": 3562.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5486.87, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5486.87, "10th_percentile": 5486.87, "90th_percentile": 5486.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3064.09, "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": 3064.09, "10th_percentile": 3064.09, "90th_percentile": 3064.09, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4576.9, "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": 4576.9, "10th_percentile": 4576.9, "90th_percentile": 4576.9, "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": 3377.63, "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": 3377.63, "10th_percentile": 3377.63, "90th_percentile": 3377.63, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1667.44, "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": 1667.44, "10th_percentile": 1667.44, "90th_percentile": 1667.44, "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": 1667.44, "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": 1667.44, "10th_percentile": 1667.44, "90th_percentile": 1667.44, "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 SELECT", "standard_charge_dollar": 1667.44, "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": 1667.44, "10th_percentile": 1667.44, "90th_percentile": 1667.44, "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." } ] } ] }, { "description": "AUGMENT TBL SZ7/8 15MM LFT LTRL RGHT KN CC RVSN ATTN", "code_information": [ { "code": "SUP-434153", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1808.23, "maximum": 10892.97, "setting": "outpatient", "gross_charge": 10892.97, "discounted_cash": 7625.08, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1808.23, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "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": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "count": "0", "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": 8714.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8714.38, "10th_percentile": 8714.38, "90th_percentile": 8714.38, "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 HMO", "standard_charge_dollar": 2308.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2308.22, "10th_percentile": 2308.22, "90th_percentile": 2308.22, "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": 2973.78, "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": 2973.78, "10th_percentile": 2973.78, "90th_percentile": 2973.78, "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 ASA", "standard_charge_dollar": 4956.3, "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": 4956.3, "10th_percentile": 4956.3, "90th_percentile": 4956.3, "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": 4683.98, "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": 4683.98, "10th_percentile": 4683.98, "90th_percentile": 4683.98, "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": "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: $10,892.97 @ 12.8% = $1,394.30 due to $0.00 Claim Price", "median_amount": 1394.3, "10th_percentile": 1394.3, "90th_percentile": 1394.3, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10,892.97 @ 12.8% = $1,394.30 due to $0.00 Claim Price" }, { "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": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "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 PPO", "standard_charge_dollar": 2973.78, "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": 2973.78, "10th_percentile": 2973.78, "90th_percentile": 2973.78, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 8714.38, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8714.38, "10th_percentile": 8714.38, "90th_percentile": 8714.38, "count": "0", "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": 2308.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2308.22, "10th_percentile": 2308.22, "90th_percentile": 2308.22, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 10892.97, "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 $10,892.97 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "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 $10,892.97 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10892.97, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 10892.97, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 10892.97, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 10892.97, "10th_percentile": 10892.97, "90th_percentile": 10892.97, "count": "0", "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": 5740.6, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 5163.27, "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": 5163.27, "10th_percentile": 5163.27, "90th_percentile": 5163.27, "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": 8387.59, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 8387.59, "10th_percentile": 8387.59, "90th_percentile": 8387.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2287.52, "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": 2287.52, "10th_percentile": 2287.52, "90th_percentile": 2287.52, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 9803.67, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 9803.67, "10th_percentile": 9803.67, "90th_percentile": 9803.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 6996.55, "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": 6996.55, "10th_percentile": 6996.55, "90th_percentile": 6996.55, "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 BROAD", "standard_charge_dollar": 5293.98, "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": 5293.98, "10th_percentile": 5293.98, "90th_percentile": 5293.98, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6960.61, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6960.61, "10th_percentile": 6960.61, "90th_percentile": 6960.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 5446.49, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5446.49, "10th_percentile": 5446.49, "90th_percentile": 5446.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2548.95, "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": 2548.95, "10th_percentile": 2548.95, "90th_percentile": 2548.95, "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": 2548.95, "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": 2548.95, "10th_percentile": 2548.95, "90th_percentile": 2548.95, "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 SELECT", "standard_charge_dollar": 2548.95, "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": 2548.95, "10th_percentile": 2548.95, "90th_percentile": 2548.95, "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." } ] } ] }, { "description": "AUGMENT TIB 5MM SZEF RT MEDIAL HALF BLOCK PERSONA", "code_information": [ { "code": "SUP-352595", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1280.92, "maximum": 7716.37, "setting": "outpatient", "gross_charge": 7716.37, "discounted_cash": 5401.46, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1280.92, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,716.37 @ 12.8% = $987.70 due to $0.00 Claim Price", "median_amount": 987.7, "10th_percentile": 987.7, "90th_percentile": 987.7, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,716.37 @ 12.8% = $987.70 due to $0.00 Claim Price" }, { "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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": 6173.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6173.1, "10th_percentile": 6173.1, "90th_percentile": 6173.1, "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": 6173.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6173.1, "10th_percentile": 6173.1, "90th_percentile": 6173.1, "count": "0", "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": 1635.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1635.1, "10th_percentile": 1635.1, "90th_percentile": 1635.1, "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": 1635.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1635.1, "10th_percentile": 1635.1, "90th_percentile": 1635.1, "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": 2106.57, "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": 2106.57, "10th_percentile": 2106.57, "90th_percentile": 2106.57, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2106.57, "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": 2106.57, "10th_percentile": 2106.57, "90th_percentile": 2106.57, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7716.37, "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 $7,716.37 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "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 $7,716.37 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": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7716.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7716.37, "10th_percentile": 7716.37, "90th_percentile": 7716.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4066.53, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1620.44, "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": 1620.44, "10th_percentile": 1620.44, "90th_percentile": 1620.44, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6944.73, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6944.73, "10th_percentile": 6944.73, "90th_percentile": 6944.73, "count": "0", "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": 3750.16, "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": 3750.16, "10th_percentile": 3750.16, "90th_percentile": 3750.16, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3510.95, "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": 3510.95, "10th_percentile": 3510.95, "90th_percentile": 3510.95, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4930.76, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4930.76, "10th_percentile": 4930.76, "90th_percentile": 4930.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3858.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3858.19, "10th_percentile": 3858.19, "90th_percentile": 3858.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5941.6, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5941.6, "10th_percentile": 5941.6, "90th_percentile": 5941.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3318.04, "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": 3318.04, "10th_percentile": 3318.04, "90th_percentile": 3318.04, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4956.22, "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": 4956.22, "10th_percentile": 4956.22, "90th_percentile": 4956.22, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3657.56, "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": 3657.56, "10th_percentile": 3657.56, "90th_percentile": 3657.56, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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 SELECT", "standard_charge_dollar": 1805.63, "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": 1805.63, "10th_percentile": 1805.63, "90th_percentile": 1805.63, "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." } ] } ] }, { "description": "AUGMENT TIB SM TRAB METAL CENTRAL REV PERSONA", "code_information": [ { "code": "SUP-374147", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 5967.91, "maximum": 35951.26, "setting": "outpatient", "gross_charge": 35951.26, "discounted_cash": 25165.88, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5967.91, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $35,951.26 @ 12.8% = $4,601.76 due to $0.00 Claim Price", "median_amount": 4601.76, "10th_percentile": 4601.76, "90th_percentile": 4601.76, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $35,951.26 @ 12.8% = $4,601.76 due to $0.00 Claim Price" }, { "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": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "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": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "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": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "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 BCBS PPO", "standard_charge_dollar": 9814.69, "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": 9814.69, "10th_percentile": 9814.69, "90th_percentile": 9814.69, "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": 9814.69, "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": 9814.69, "10th_percentile": 9814.69, "90th_percentile": 9814.69, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 28761.01, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 28761.01, "10th_percentile": 28761.01, "90th_percentile": 28761.01, "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": 28761.01, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 28761.01, "10th_percentile": 28761.01, "90th_percentile": 28761.01, "count": "0", "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": 7618.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 7618.07, "10th_percentile": 7618.07, "90th_percentile": 7618.07, "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": 7618.07, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 7618.07, "10th_percentile": 7618.07, "90th_percentile": 7618.07, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 35951.26, "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 $35,951.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "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 $35,951.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 35951.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 35951.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 35951.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 35951.26, "10th_percentile": 35951.26, "90th_percentile": 35951.26, "count": "0", "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": 18946.31, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 17040.9, "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": 17040.9, "10th_percentile": 17040.9, "90th_percentile": 17040.9, "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": 27682.47, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 27682.47, "10th_percentile": 27682.47, "90th_percentile": 27682.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 7549.76, "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": 7549.76, "10th_percentile": 7549.76, "90th_percentile": 7549.76, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 32356.13, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 32356.13, "10th_percentile": 32356.13, "90th_percentile": 32356.13, "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": 16357.82, "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": 16357.82, "10th_percentile": 16357.82, "90th_percentile": 16357.82, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 23091.49, "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": 23091.49, "10th_percentile": 23091.49, "90th_percentile": 23091.49, "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 BROAD", "standard_charge_dollar": 17472.31, "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": 17472.31, "10th_percentile": 17472.31, "90th_percentile": 17472.31, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 22972.86, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 22972.86, "10th_percentile": 22972.86, "90th_percentile": 22972.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 17975.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 17975.63, "10th_percentile": 17975.63, "90th_percentile": 17975.63, "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", "standard_charge_dollar": 15459.04, "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": 15459.04, "10th_percentile": 15459.04, "90th_percentile": 15459.04, "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": 8412.59, "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": 8412.59, "10th_percentile": 8412.59, "90th_percentile": 8412.59, "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": 8412.59, "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": 8412.59, "10th_percentile": 8412.59, "90th_percentile": 8412.59, "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 SELECT", "standard_charge_dollar": 8412.59, "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": 8412.59, "10th_percentile": 8412.59, "90th_percentile": 8412.59, "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." } ] } ] }, { "description": "AUGMENT TIB SZ D ASSYM CONE TRIATHLON LM RL", "code_information": [ { "code": "SUP-374419", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 5635.74, "maximum": 33950.27, "setting": "outpatient", "gross_charge": 33950.27, "discounted_cash": 23765.19, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5635.74, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $33,950.27 @ 12.8% = $4,345.63 due to $0.00 Claim Price", "median_amount": 4345.63, "10th_percentile": 4345.63, "90th_percentile": 4345.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $33,950.27 @ 12.8% = $4,345.63 due to $0.00 Claim Price" }, { "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": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "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": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "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": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "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": 27160.22, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 27160.22, "10th_percentile": 27160.22, "90th_percentile": 27160.22, "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": 27160.22, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 27160.22, "10th_percentile": 27160.22, "90th_percentile": 27160.22, "count": "0", "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": 7194.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 7194.06, "10th_percentile": 7194.06, "90th_percentile": 7194.06, "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": 7194.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 7194.06, "10th_percentile": 7194.06, "90th_percentile": 7194.06, "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": 9268.42, "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": 9268.42, "10th_percentile": 9268.42, "90th_percentile": 9268.42, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 9268.42, "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": 9268.42, "10th_percentile": 9268.42, "90th_percentile": 9268.42, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 33950.27, "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 $33,950.27 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "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 $33,950.27 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": 33950.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 33950.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 33950.27, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 33950.27, "10th_percentile": 33950.27, "90th_percentile": 33950.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 17891.79, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 7129.56, "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": 7129.56, "10th_percentile": 7129.56, "90th_percentile": 7129.56, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 30555.24, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 30555.24, "10th_percentile": 30555.24, "90th_percentile": 30555.24, "count": "0", "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": 16499.83, "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": 16499.83, "10th_percentile": 16499.83, "90th_percentile": 16499.83, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 15447.37, "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": 15447.37, "10th_percentile": 15447.37, "90th_percentile": 15447.37, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 21694.22, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 21694.22, "10th_percentile": 21694.22, "90th_percentile": 21694.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 16975.14, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 16975.14, "10th_percentile": 16975.14, "90th_percentile": 16975.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 26141.71, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 26141.71, "10th_percentile": 26141.71, "90th_percentile": 26141.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 14598.62, "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": 14598.62, "10th_percentile": 14598.62, "90th_percentile": 14598.62, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 21806.26, "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": 21806.26, "10th_percentile": 21806.26, "90th_percentile": 21806.26, "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 CORE", "standard_charge_dollar": 16092.43, "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": 16092.43, "10th_percentile": 16092.43, "90th_percentile": 16092.43, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 7944.36, "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": 7944.36, "10th_percentile": 7944.36, "90th_percentile": 7944.36, "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": 7944.36, "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": 7944.36, "10th_percentile": 7944.36, "90th_percentile": 7944.36, "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 SELECT", "standard_charge_dollar": 7944.36, "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": 7944.36, "10th_percentile": 7944.36, "90th_percentile": 7944.36, "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." } ] } ] }, { "description": "AUGMENT TIB SZ6 12MM DSTL KN CC MOLY CMNTD REV ATTUNE", "code_information": [ { "code": "SUP-417048", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1619.65, "maximum": 9756.93, "setting": "outpatient", "gross_charge": 9756.93, "discounted_cash": 6829.85, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1619.65, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $9,756.93 @ 12.8% = $1,248.89 due to $0.00 Claim Price", "median_amount": 1248.89, "10th_percentile": 1248.89, "90th_percentile": 1248.89, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $9,756.93 @ 12.8% = $1,248.89 due to $0.00 Claim Price" }, { "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": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "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": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "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": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "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": 7805.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7805.54, "10th_percentile": 7805.54, "90th_percentile": 7805.54, "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": 7805.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7805.54, "10th_percentile": 7805.54, "90th_percentile": 7805.54, "count": "0", "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": 2067.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2067.49, "10th_percentile": 2067.49, "90th_percentile": 2067.49, "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": 2067.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2067.49, "10th_percentile": 2067.49, "90th_percentile": 2067.49, "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": 2663.64, "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": 2663.64, "10th_percentile": 2663.64, "90th_percentile": 2663.64, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2663.64, "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": 2663.64, "10th_percentile": 2663.64, "90th_percentile": 2663.64, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 9756.93, "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 $9,756.93 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "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 $9,756.93 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": 9756.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9756.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 9756.93, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 9756.93, "10th_percentile": 9756.93, "90th_percentile": 9756.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 5141.9, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2048.96, "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": 2048.96, "10th_percentile": 2048.96, "90th_percentile": 2048.96, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 8781.24, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 8781.24, "10th_percentile": 8781.24, "90th_percentile": 8781.24, "count": "0", "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": 4741.87, "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": 4741.87, "10th_percentile": 4741.87, "90th_percentile": 4741.87, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 4439.4, "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": 4439.4, "10th_percentile": 4439.4, "90th_percentile": 4439.4, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6234.68, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6234.68, "10th_percentile": 6234.68, "90th_percentile": 6234.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 4878.47, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4878.47, "10th_percentile": 4878.47, "90th_percentile": 4878.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 7512.84, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 7512.84, "10th_percentile": 7512.84, "90th_percentile": 7512.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 4195.48, "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": 4195.48, "10th_percentile": 4195.48, "90th_percentile": 4195.48, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 6266.88, "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": 6266.88, "10th_percentile": 6266.88, "90th_percentile": 6266.88, "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": 4624.78, "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": 4624.78, "10th_percentile": 4624.78, "90th_percentile": 4624.78, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 2283.12, "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": 2283.12, "10th_percentile": 2283.12, "90th_percentile": 2283.12, "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": 2283.12, "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": 2283.12, "10th_percentile": 2283.12, "90th_percentile": 2283.12, "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 SELECT", "standard_charge_dollar": 2283.12, "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": 2283.12, "10th_percentile": 2283.12, "90th_percentile": 2283.12, "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." } ] } ] }, { "description": "AVANCE NERVE GRAFT 1-2MM X 30MM", "code_information": [ { "code": "SUP-163402", "type": "CDM" }, { "code": "C1762", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 4361.44, "maximum": 26273.72, "setting": "outpatient", "gross_charge": 26273.72, "discounted_cash": 18391.6, "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": 26273.72, "10th_percentile": 26273.72, "90th_percentile": 26273.72, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 26273.72, "10th_percentile": 26273.72, "90th_percentile": 26273.72, "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": 26273.72, "10th_percentile": 26273.72, "90th_percentile": 26273.72, "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": 26273.72, "10th_percentile": 26273.72, "90th_percentile": 26273.72, "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_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: $26,273.72 @ 12.8% = $3,363.04 due to $0.00 Claim Price", "median_amount": 3363.04, "10th_percentile": 3363.04, "90th_percentile": 3363.04, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $26,273.72 @ 12.8% = $3,363.04 due to $0.00 Claim Price" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 12769.03, "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": 12769.03, "10th_percentile": 12769.03, "90th_percentile": 12769.03, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 11823.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 11823.17, "10th_percentile": 11823.17, "90th_percentile": 11823.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 13846.25, "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": 13846.25, "10th_percentile": 13846.25, "90th_percentile": 13846.25, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 5517.48, "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": 5517.48, "10th_percentile": 5517.48, "90th_percentile": 5517.48, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 4361.44, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 4361.44, "10th_percentile": 4361.44, "90th_percentile": 4361.44, "count": "0", "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": 16875.61, "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": 16875.61, "10th_percentile": 16875.61, "90th_percentile": 16875.61, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 16788.91, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 16788.91, "10th_percentile": 16788.91, "90th_percentile": 16788.91, "count": "0", "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": 12453.74, "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": 12453.74, "10th_percentile": 12453.74, "90th_percentile": 12453.74, "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": 23646.35, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 23646.35, "10th_percentile": 23646.35, "90th_percentile": 23646.35, "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": 11954.54, "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": 11954.54, "10th_percentile": 11954.54, "90th_percentile": 11954.54, "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": 11297.7, "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": 11297.7, "10th_percentile": 11297.7, "90th_percentile": 11297.7, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 26273.72, "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 $26,273.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 26273.72, "10th_percentile": 26273.72, "90th_percentile": 26273.72, "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 $26,273.72 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 26273.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 26273.72, "10th_percentile": 26273.72, "90th_percentile": 26273.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 26273.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 26273.72, "10th_percentile": 26273.72, "90th_percentile": 26273.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 13136.86, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 13136.86, "10th_percentile": 13136.86, "90th_percentile": 13136.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 20230.76, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 20230.76, "10th_percentile": 20230.76, "90th_percentile": 20230.76, "count": "0", "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": 5567.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5567.4, "10th_percentile": 5567.4, "90th_percentile": 5567.4, "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 HMO", "standard_charge_dollar": 5567.4, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5567.4, "10th_percentile": 5567.4, "90th_percentile": 5567.4, "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": 7172.73, "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": 7172.73, "10th_percentile": 7172.73, "90th_percentile": 7172.73, "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": 7172.73, "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": 7172.73, "10th_percentile": 7172.73, "90th_percentile": 7172.73, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 21018.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 21018.98, "10th_percentile": 21018.98, "90th_percentile": 21018.98, "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": 21018.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 21018.98, "10th_percentile": 21018.98, "90th_percentile": 21018.98, "count": "0", "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 OPTIONS", "standard_charge_dollar": 6148.05, "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": 6148.05, "10th_percentile": 6148.05, "90th_percentile": 6148.05, "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": 6148.05, "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": 6148.05, "10th_percentile": 6148.05, "90th_percentile": 6148.05, "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 SELECT", "standard_charge_dollar": 6148.05, "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": 6148.05, "10th_percentile": 6148.05, "90th_percentile": 6148.05, "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." } ] } ] }, { "description": "AXIEM TRACER POINTER / PROBE 9735428 (2 of 2 parts)", "code_information": [ { "code": "SUP-358865", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1011.17, "maximum": 6091.4, "setting": "outpatient", "gross_charge": 6091.4, "discounted_cash": 4263.98, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1663.56, "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": 1663.56, "10th_percentile": 1663.56, "90th_percentile": 1663.56, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1663.56, "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": 1663.56, "10th_percentile": 1663.56, "90th_percentile": 1663.56, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1290.77, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1290.77, "10th_percentile": 1290.77, "90th_percentile": 1290.77, "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 HMO", "standard_charge_dollar": 1290.77, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1290.77, "10th_percentile": 1290.77, "90th_percentile": 1290.77, "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": 4873.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4873.12, "10th_percentile": 4873.12, "90th_percentile": 4873.12, "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": 4873.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4873.12, "10th_percentile": 4873.12, "90th_percentile": 4873.12, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 6091.4, "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 $6,091.40 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "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 $6,091.40 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": 1417.47, "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": 1417.47, "10th_percentile": 1417.47, "90th_percentile": 1417.47, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 1340.72, "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": 1340.72, "10th_percentile": 1340.72, "90th_percentile": 1340.72, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 2741.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2741.13, "10th_percentile": 2741.13, "90th_percentile": 2741.13, "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": 1276.76, "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": 1276.76, "10th_percentile": 1276.76, "90th_percentile": 1276.76, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 5482.26, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5482.26, "10th_percentile": 5482.26, "90th_percentile": 5482.26, "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": 3045.7, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3045.7, "10th_percentile": 3045.7, "90th_percentile": 3045.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4994.95, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 4994.95, "10th_percentile": 4994.95, "90th_percentile": 4994.95, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 2960.42, "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": 2960.42, "10th_percentile": 2960.42, "90th_percentile": 2960.42, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6091.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3892.4, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3892.4, "10th_percentile": 3892.4, "90th_percentile": 3892.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6091.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1011.17, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1011.17, "10th_percentile": 1011.17, "90th_percentile": 1011.17, "count": "0", "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": 3912.51, "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": 3912.51, "10th_percentile": 3912.51, "90th_percentile": 3912.51, "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": 3210.17, "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": 3210.17, "10th_percentile": 3210.17, "90th_percentile": 3210.17, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2887.32, "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": 2887.32, "10th_percentile": 2887.32, "90th_percentile": 2887.32, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1279.19, "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": 1279.19, "10th_percentile": 1279.19, "90th_percentile": 1279.19, "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": 2619.3, "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": 2619.3, "10th_percentile": 2619.3, "90th_percentile": 2619.3, "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 ASA", "standard_charge_dollar": 2771.59, "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": 2771.59, "10th_percentile": 2771.59, "90th_percentile": 2771.59, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "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": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "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": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "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": 6091.4, "10th_percentile": 6091.4, "90th_percentile": 6091.4, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "AXIUM PRIME COIL DETACHABLE 3D FRAME 4MMX8CM", "code_information": [ { "code": "SUP-357942", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2765.62, "maximum": 16660.34, "setting": "outpatient", "gross_charge": 16660.34, "discounted_cash": 11662.24, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2765.62, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 8780.0, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 3498.67, "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": 3498.67, "10th_percentile": 3498.67, "90th_percentile": 3498.67, "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": 8096.93, "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": 8096.93, "10th_percentile": 8096.93, "90th_percentile": 8096.93, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 10645.96, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 10645.96, "10th_percentile": 10645.96, "90th_percentile": 10645.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 12828.46, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 12828.46, "10th_percentile": 12828.46, "90th_percentile": 12828.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 7580.45, "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": 7580.45, "10th_percentile": 7580.45, "90th_percentile": 7580.45, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 10700.94, "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": 10700.94, "10th_percentile": 10700.94, "90th_percentile": 10700.94, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 8330.17, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "count": "0", "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": 7897.0, "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": 7897.0, "10th_percentile": 7897.0, "90th_percentile": 7897.0, "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": 14994.31, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 14994.31, "10th_percentile": 14994.31, "90th_percentile": 14994.31, "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": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7497.15, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 7497.15, "10th_percentile": 7497.15, "90th_percentile": 7497.15, "count": "0", "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": 7163.95, "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": 7163.95, "10th_percentile": 7163.95, "90th_percentile": 7163.95, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 16660.34, "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 $16,660.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 16660.34, "10th_percentile": 16660.34, "90th_percentile": 16660.34, "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 $16,660.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 16660.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 16660.34, "10th_percentile": 16660.34, "90th_percentile": 16660.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 16660.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 16660.34, "10th_percentile": 16660.34, "90th_percentile": 16660.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 13328.27, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 13328.27, "10th_percentile": 13328.27, "90th_percentile": 13328.27, "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": 13328.27, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 13328.27, "10th_percentile": 13328.27, "90th_percentile": 13328.27, "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": 3530.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3530.33, "10th_percentile": 3530.33, "90th_percentile": 3530.33, "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 HMO", "standard_charge_dollar": 3530.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3530.33, "10th_percentile": 3530.33, "90th_percentile": 3530.33, "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": 4548.27, "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": 4548.27, "10th_percentile": 4548.27, "90th_percentile": 4548.27, "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": 4548.27, "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": 4548.27, "10th_percentile": 4548.27, "90th_percentile": 4548.27, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 3898.52, "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": 3898.52, "10th_percentile": 3898.52, "90th_percentile": 3898.52, "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": 3898.52, "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": 3898.52, "10th_percentile": 3898.52, "90th_percentile": 3898.52, "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": 3898.52, "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": 3898.52, "10th_percentile": 3898.52, "90th_percentile": 3898.52, "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": "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": 16660.34, "10th_percentile": 16660.34, "90th_percentile": 16660.34, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 16660.34, "10th_percentile": 16660.34, "90th_percentile": 16660.34, "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": 16660.34, "10th_percentile": 16660.34, "90th_percentile": 16660.34, "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": 16660.34, "10th_percentile": 16660.34, "90th_percentile": 16660.34, "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_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: $16,660.34 @ 12.8% = $2,132.52 due to $0.00 Claim Price", "median_amount": 2132.52, "10th_percentile": 2132.52, "90th_percentile": 2132.52, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $16,660.34 @ 12.8% = $2,132.52 due to $0.00 Claim Price" } ] } ] }, { "description": "Adult Oxygen Mask Non-Rebreather 7Ft", "code_information": [ { "code": "SUP-161453", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 1.93, "maximum": 11.6, "setting": "outpatient", "gross_charge": 11.6, "discounted_cash": 8.12, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "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": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "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": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "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": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "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": 9.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "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": 9.28, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "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": 2.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "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 HMO", "standard_charge_dollar": 2.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2.46, "10th_percentile": 2.46, "90th_percentile": 2.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 11.6, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 11.6, "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 $11.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "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 $11.60 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 5.8, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5.8, "10th_percentile": 5.8, "90th_percentile": 5.8, "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": 10.44, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 10.44, "10th_percentile": 10.44, "90th_percentile": 10.44, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 7.41, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 7.41, "10th_percentile": 7.41, "90th_percentile": 7.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 5.22, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 5.22, "10th_percentile": 5.22, "90th_percentile": 5.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 5.5, "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": 5.5, "10th_percentile": 5.5, "90th_percentile": 5.5, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2.55, "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": 2.55, "10th_percentile": 2.55, "90th_percentile": 2.55, "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": 2.7, "10th_percentile": 2.7, "90th_percentile": 2.7, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 7.45, "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": 7.45, "10th_percentile": 7.45, "90th_percentile": 7.45, "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": "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": 1.93, "10th_percentile": 1.93, "90th_percentile": 1.93, "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 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": 2.44, "10th_percentile": 2.44, "90th_percentile": 2.44, "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": 4.99, "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": 4.99, "10th_percentile": 4.99, "90th_percentile": 4.99, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 5.64, "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": 5.64, "10th_percentile": 5.64, "90th_percentile": 5.64, "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": 9.51, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 9.51, "10th_percentile": 9.51, "90th_percentile": 9.51, "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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 2.43, "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": 2.43, "10th_percentile": 2.43, "90th_percentile": 2.43, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 5.28, "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": 5.28, "10th_percentile": 5.28, "90th_percentile": 5.28, "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": 6.11, "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": 6.11, "10th_percentile": 6.11, "90th_percentile": 6.11, "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": "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": 3.17, "10th_percentile": 3.17, "90th_percentile": 3.17, "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": "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": 3.17, "10th_percentile": 3.17, "90th_percentile": 3.17, "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." } ] } ] }, { "description": "Apex RX Balloon 2.5 x 15mm", "code_information": [ { "code": "SUP-301832", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 123.72, "maximum": 745.33, "setting": "outpatient", "gross_charge": 745.33, "discounted_cash": 521.73, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 392.79, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $745.33 @ 12.8% = $95.40 due to $0.00 Claim Price", "median_amount": 95.4, "10th_percentile": 95.4, "90th_percentile": 95.4, "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: $745.33 @ 12.8% = $95.40 due to $0.00 Claim Price" }, { "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 353.29, "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": 353.29, "10th_percentile": 353.29, "90th_percentile": 353.29, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 478.73, "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": 478.73, "10th_percentile": 478.73, "90th_percentile": 478.73, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 335.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 335.4, "10th_percentile": 335.4, "90th_percentile": 335.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 372.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 372.67, "10th_percentile": 372.67, "90th_percentile": 372.67, "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", "standard_charge_dollar": 320.49, "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": 320.49, "10th_percentile": 320.49, "90th_percentile": 320.49, "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": 123.72, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 123.72, "10th_percentile": 123.72, "90th_percentile": 123.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 476.27, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 476.27, "10th_percentile": 476.27, "90th_percentile": 476.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 611.17, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 611.17, "10th_percentile": 611.17, "90th_percentile": 611.17, "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 $19,355 CASE RATE" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 339.13, "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": 339.13, "10th_percentile": 339.13, "90th_percentile": 339.13, "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 BROAD", "standard_charge_dollar": 362.23, "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": 362.23, "10th_percentile": 362.23, "90th_percentile": 362.23, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 156.52, "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": 156.52, "10th_percentile": 156.52, "90th_percentile": 156.52, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 670.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 670.8, "10th_percentile": 670.8, "90th_percentile": 670.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 596.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 596.26, "10th_percentile": 596.26, "90th_percentile": 596.26, "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": 596.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 596.26, "10th_percentile": 596.26, "90th_percentile": 596.26, "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": 157.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 157.94, "10th_percentile": 157.94, "90th_percentile": 157.94, "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 HMO", "standard_charge_dollar": 157.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 157.94, "10th_percentile": 157.94, "90th_percentile": 157.94, "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": 203.48, "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": 203.48, "10th_percentile": 203.48, "90th_percentile": 203.48, "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": 203.48, "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": 203.48, "10th_percentile": 203.48, "90th_percentile": 203.48, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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 SELECT", "standard_charge_dollar": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 745.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 745.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 745.33, "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 $745.33 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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 $745.33 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "Apex RX Balloon 3.0 x 15mm", "code_information": [ { "code": "SUP-125194", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 123.72, "maximum": 745.33, "setting": "outpatient", "gross_charge": 745.33, "discounted_cash": 521.73, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 392.79, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $745.33 @ 12.8% = $95.40 due to $0.00 Claim Price", "median_amount": 95.4, "10th_percentile": 95.4, "90th_percentile": 95.4, "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: $745.33 @ 12.8% = $95.40 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 353.29, "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": 353.29, "10th_percentile": 353.29, "90th_percentile": 353.29, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 478.73, "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": 478.73, "10th_percentile": 478.73, "90th_percentile": 478.73, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 335.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 335.4, "10th_percentile": 335.4, "90th_percentile": 335.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 372.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 372.67, "10th_percentile": 372.67, "90th_percentile": 372.67, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 476.27, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 476.27, "10th_percentile": 476.27, "90th_percentile": 476.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 611.17, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 611.17, "10th_percentile": 611.17, "90th_percentile": 611.17, "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 $19,355 CASE RATE" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 362.23, "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": 362.23, "10th_percentile": 362.23, "90th_percentile": 362.23, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 156.52, "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": 156.52, "10th_percentile": 156.52, "90th_percentile": 156.52, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 670.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 670.8, "10th_percentile": 670.8, "90th_percentile": 670.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 596.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 596.26, "10th_percentile": 596.26, "90th_percentile": 596.26, "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": 596.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 596.26, "10th_percentile": 596.26, "90th_percentile": 596.26, "count": "0", "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": 157.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 157.94, "10th_percentile": 157.94, "90th_percentile": 157.94, "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": 203.48, "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": 203.48, "10th_percentile": 203.48, "90th_percentile": 203.48, "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": 203.48, "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": 203.48, "10th_percentile": 203.48, "90th_percentile": 203.48, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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 SELECT", "standard_charge_dollar": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 745.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 745.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 745.33, "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 $745.33 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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 $745.33 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": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 339.13, "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": 339.13, "10th_percentile": 339.13, "90th_percentile": 339.13, "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 NM EMPLOYEES", "standard_charge_dollar": 123.72, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 123.72, "10th_percentile": 123.72, "90th_percentile": 123.72, "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", "standard_charge_dollar": 320.49, "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": 320.49, "10th_percentile": 320.49, "90th_percentile": 320.49, "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": 157.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 157.94, "10th_percentile": 157.94, "90th_percentile": 157.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" } ] } ] }, { "description": "Apex RX Balloon 4.0 x 40mm", "code_information": [ { "code": "SUP-313885", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 123.72, "maximum": 745.33, "setting": "outpatient", "gross_charge": 745.33, "discounted_cash": 521.73, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 392.79, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $745.33 @ 12.8% = $95.40 due to $0.00 Claim Price", "median_amount": 95.4, "10th_percentile": 95.4, "90th_percentile": 95.4, "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: $745.33 @ 12.8% = $95.40 due to $0.00 Claim Price" }, { "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 353.29, "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": 353.29, "10th_percentile": 353.29, "90th_percentile": 353.29, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 478.73, "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": 478.73, "10th_percentile": 478.73, "90th_percentile": 478.73, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 335.4, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 335.4, "10th_percentile": 335.4, "90th_percentile": 335.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 372.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 372.67, "10th_percentile": 372.67, "90th_percentile": 372.67, "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", "standard_charge_dollar": 320.49, "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": 320.49, "10th_percentile": 320.49, "90th_percentile": 320.49, "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": 123.72, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 123.72, "10th_percentile": 123.72, "90th_percentile": 123.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 476.27, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 476.27, "10th_percentile": 476.27, "90th_percentile": 476.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 611.17, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 611.17, "10th_percentile": 611.17, "90th_percentile": 611.17, "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 $19,355 CASE RATE" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 339.13, "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": 339.13, "10th_percentile": 339.13, "90th_percentile": 339.13, "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 BROAD", "standard_charge_dollar": 362.23, "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": 362.23, "10th_percentile": 362.23, "90th_percentile": 362.23, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 156.52, "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": 156.52, "10th_percentile": 156.52, "90th_percentile": 156.52, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 670.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 670.8, "10th_percentile": 670.8, "90th_percentile": 670.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 596.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 596.26, "10th_percentile": 596.26, "90th_percentile": 596.26, "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": 596.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 596.26, "10th_percentile": 596.26, "90th_percentile": 596.26, "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": 157.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 157.94, "10th_percentile": 157.94, "90th_percentile": 157.94, "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 HMO", "standard_charge_dollar": 157.94, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 157.94, "10th_percentile": 157.94, "90th_percentile": 157.94, "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": 203.48, "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": 203.48, "10th_percentile": 203.48, "90th_percentile": 203.48, "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": 203.48, "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": 203.48, "10th_percentile": 203.48, "90th_percentile": 203.48, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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 SELECT", "standard_charge_dollar": 174.41, "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": 174.41, "10th_percentile": 174.41, "90th_percentile": 174.41, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 745.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 745.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 745.33, "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 $745.33 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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 $745.33 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "Arthroscopy Hip W/Femoroplasty", "code_information": [ { "code": "CASE-29914", "type": "LOCAL" }, { "code": "29914", "type": "CPT" }, { "code": "0360", "type": "RC" } ], "standard_charges": [ { "minimum": 3270.0, "maximum": 7839.0, "setting": "outpatient", "gross_charge": 143492.98, "discounted_cash": 100445.09, "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, labs, supplies, and other services can be included in reimbursement.", "median_amount": 23819.83, "10th_percentile": 23819.83, "90th_percentile": 23819.83, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_percentage": 21.19, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 30406.17, "10th_percentile": 30406.17, "90th_percentile": 30406.17, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_percentage": 26.9, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 38599.61, "10th_percentile": 38599.61, "90th_percentile": 38599.61, "count": "1 through 10", "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, labs, supplies, and other services can be included in reimbursement.", "median_amount": 102597.5, "10th_percentile": 102597.5, "90th_percentile": 102597.5, "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 anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 143492.98, "10th_percentile": 143492.98, "90th_percentile": 143492.98, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_percentage": 23.3, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 33433.86, "10th_percentile": 33433.86, "90th_percentile": 33433.86, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_percentage": 23.3, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 33433.86, "10th_percentile": 33433.86, "90th_percentile": 33433.86, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_percentage": 23.3, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 33433.86, "10th_percentile": 33433.86, "90th_percentile": 33433.86, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_percentage": 21.19, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 30406.17, "10th_percentile": 30406.17, "90th_percentile": 30406.17, "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": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 143492.98, "10th_percentile": 143492.98, "90th_percentile": 143492.98, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_percentage": 26.9, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 38599.61, "10th_percentile": 38599.61, "90th_percentile": 38599.61, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_percentage": 37.7, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 53643.76, "10th_percentile": 53643.76, "90th_percentile": 53643.76, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_percentage": 64.8, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 92174.1, "10th_percentile": 92174.1, "90th_percentile": 92174.1, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 110489.63, "10th_percentile": 110489.63, "90th_percentile": 110489.63, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_percentage": 63.9, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 91692.03, "10th_percentile": 91692.03, "90th_percentile": 91692.03, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_percentage": 90.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 129143.74, "10th_percentile": 129143.74, "90th_percentile": 129143.74, "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": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 71746.55, "10th_percentile": 71746.55, "90th_percentile": 71746.55, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 143492.98, "10th_percentile": 143492.98, "90th_percentile": 143492.98, "count": "1 through 10", "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, labs, supplies, and other services can be included in reimbursement.", "median_amount": 102597.5, "10th_percentile": 102597.5, "90th_percentile": 102597.5, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_percentage": 64.23, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 91945.23, "10th_percentile": 91945.23, "90th_percentile": 91945.23, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "median_amount": 143492.98, "10th_percentile": 143492.98, "90th_percentile": 143492.98, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3270.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; Ambulatory Surgery; Per Diem @ $3,270.00, and; Pricing Extension - NM HB XR PRC - LESSER OF TERMS OR TOTAL CHARGES MINUS EXLCL*; Note: Accumulated terms < 100% of charges minus exclusions.", "median_amount": 4905.0, "10th_percentile": 4905.0, "90th_percentile": 4905.0, "count": "1 through 10", "methodology": "per diem" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3597.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; Ambulatory Surgery; Per Diem @ $3,597.00, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5395.5, "10th_percentile": 5395.5, "90th_percentile": 5395.5, "count": "1 through 10", "methodology": "per diem" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 7055.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; OP Surgery Group 6; Case Rate @ $7,055.00, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10627.71, "10th_percentile": 10627.71, "90th_percentile": 10627.71, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 7839.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; OP Surgery Group 6; Case Rate @ $7,839.00, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 11803.71, "10th_percentile": 11803.71, "90th_percentile": 11803.71, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; 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: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price", "median_amount": 18367.1, "10th_percentile": 18367.1, "90th_percentile": 18367.1, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; 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: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_percentage": 120.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; 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: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price", "median_amount": 18367.1, "10th_percentile": 18367.1, "90th_percentile": 18367.1, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; 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: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; 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: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 18367.1, "10th_percentile": 18367.1, "90th_percentile": 18367.1, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; 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: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price Paid at contractual rate, which is the lesser 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_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price", "median_amount": 18367.1, "10th_percentile": 18367.1, "90th_percentile": 18367.1, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price", "median_amount": 18367.1, "10th_percentile": 18367.1, "90th_percentile": 18367.1, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.734284001; Using new claim; Scope: All Financial Classes; Cases: 1; APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $143,492.99 @ 12.8% = $18,367.10 due to $0.00 Claim Price" } ] } ] }, { "description": "B COMPLEX AND C 20-FOLIC ACID 1 MG ORAL CAP", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-87637", "type": "CDM" }, { "code": "63700000", "type": "LOCAL" }, { "code": "0637", "type": "RC" }, { "code": "60258-0162-01", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.33, "maximum": 2.0, "setting": "outpatient", "gross_charge": 2.0, "discounted_cash": 1.4, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "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": 1.28, "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": 1.28, "10th_percentile": 1.28, "90th_percentile": 1.28, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1.6, "10th_percentile": 1.6, "90th_percentile": 1.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.55, "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": 0.55, "10th_percentile": 0.55, "90th_percentile": 0.55, "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": 1.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.0, "10th_percentile": 1.0, "90th_percentile": 1.0, "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 BROAD", "standard_charge_dollar": 0.97, "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": 0.97, "10th_percentile": 0.97, "90th_percentile": 0.97, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 0.95, "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": 0.95, "10th_percentile": 0.95, "90th_percentile": 0.95, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1.05, "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": 1.05, "10th_percentile": 1.05, "90th_percentile": 1.05, "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 PPO", "standard_charge_dollar": 1.8, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1.8, "10th_percentile": 1.8, "90th_percentile": 1.8, "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", "standard_charge_dollar": 0.86, "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": 0.86, "10th_percentile": 0.86, "90th_percentile": 0.86, "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 ASA", "standard_charge_dollar": 0.91, "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": 0.91, "10th_percentile": 0.91, "90th_percentile": 0.91, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1.64, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1.64, "10th_percentile": 1.64, "90th_percentile": 1.64, "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": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 0.47, "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": 0.47, "10th_percentile": 0.47, "90th_percentile": 0.47, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 0.44, "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": 0.44, "10th_percentile": 0.44, "90th_percentile": 0.44, "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": 0.33, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.33, "10th_percentile": 0.33, "90th_percentile": 0.33, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 0.9, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 0.9, "10th_percentile": 0.9, "90th_percentile": 0.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.42, "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": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 0.42, "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": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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 HMO", "standard_charge_dollar": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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": 0.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.42, "10th_percentile": 0.42, "90th_percentile": 0.42, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2.0, "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": 2.0, "10th_percentile": 2.0, "90th_percentile": 2.0, "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 $2.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." } ] } ] }, { "description": "BAG DRNGE URIMTR INF CTRL 2500ML 350ML", "code_information": [ { "code": "SUP-104099", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 36.54, "maximum": 220.1, "setting": "outpatient", "gross_charge": 220.1, "discounted_cash": 154.07, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 176.08, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 176.08, "10th_percentile": 176.08, "90th_percentile": 176.08, "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": 176.08, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 176.08, "10th_percentile": 176.08, "90th_percentile": 176.08, "count": "0", "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": 60.11, "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": 60.11, "10th_percentile": 60.11, "90th_percentile": 60.11, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 60.11, "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": 60.11, "10th_percentile": 60.11, "90th_percentile": 60.11, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 46.64, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 46.64, "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 HMO", "standard_charge_dollar": 46.64, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 46.64, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 220.1, "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 $220.10 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "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 $220.10 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 48.44, "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": 48.44, "10th_percentile": 48.44, "90th_percentile": 48.44, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 99.05, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 99.05, "10th_percentile": 99.05, "90th_percentile": 99.05, "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 OPTIONS", "standard_charge_dollar": 51.22, "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": 51.22, "10th_percentile": 51.22, "90th_percentile": 51.22, "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 BCBS BLUECHOICE SELECT", "standard_charge_dollar": 46.13, "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": 46.13, "10th_percentile": 46.13, "90th_percentile": 46.13, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 141.37, "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": 141.37, "10th_percentile": 141.37, "90th_percentile": 141.37, "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 BROAD", "standard_charge_dollar": 106.97, "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": 106.97, "10th_percentile": 106.97, "90th_percentile": 106.97, "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": 180.48, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 180.48, "10th_percentile": 180.48, "90th_percentile": 180.48, "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": 110.05, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 110.05, "10th_percentile": 110.05, "90th_percentile": 110.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 220.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 36.54, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 36.54, "10th_percentile": 36.54, "90th_percentile": 36.54, "count": "0", "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": 104.33, "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": 104.33, "10th_percentile": 104.33, "90th_percentile": 104.33, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 100.15, "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": 100.15, "10th_percentile": 100.15, "90th_percentile": 100.15, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 115.99, "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": 115.99, "10th_percentile": 115.99, "90th_percentile": 115.99, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 220.1, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 46.22, "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": 46.22, "10th_percentile": 46.22, "90th_percentile": 46.22, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 140.64, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 140.64, "10th_percentile": 140.64, "90th_percentile": 140.64, "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": 94.64, "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": 94.64, "10th_percentile": 94.64, "90th_percentile": 94.64, "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": 198.09, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 198.09, "10th_percentile": 198.09, "90th_percentile": 198.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "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": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "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": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "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": 220.1, "10th_percentile": 220.1, "90th_percentile": 220.1, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BAG INFUS STPCOCK AIR CTRL INFU-SURG 3000ML", "code_information": [ { "code": "SUP-137906", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 46.54, "maximum": 280.39, "setting": "outpatient", "gross_charge": 280.39, "discounted_cash": 196.27, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 224.31, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 224.31, "10th_percentile": 224.31, "90th_percentile": 224.31, "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": 224.31, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 224.31, "10th_percentile": 224.31, "90th_percentile": 224.31, "count": "0", "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": 76.57, "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": 76.57, "10th_percentile": 76.57, "90th_percentile": 76.57, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 76.57, "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": 76.57, "10th_percentile": 76.57, "90th_percentile": 76.57, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 59.41, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 59.41, "10th_percentile": 59.41, "90th_percentile": 59.41, "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 HMO", "standard_charge_dollar": 59.41, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 59.41, "10th_percentile": 59.41, "90th_percentile": 59.41, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 280.39, "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 $280.39 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "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 $280.39 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 61.71, "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": 61.71, "10th_percentile": 61.71, "90th_percentile": 61.71, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 126.18, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 126.18, "10th_percentile": 126.18, "90th_percentile": 126.18, "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 OPTIONS", "standard_charge_dollar": 65.25, "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": 65.25, "10th_percentile": 65.25, "90th_percentile": 65.25, "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 BLUECHOICE SELECT", "standard_charge_dollar": 58.77, "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": 58.77, "10th_percentile": 58.77, "90th_percentile": 58.77, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 180.09, "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": 180.09, "10th_percentile": 180.09, "90th_percentile": 180.09, "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 BROAD", "standard_charge_dollar": 136.27, "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": 136.27, "10th_percentile": 136.27, "90th_percentile": 136.27, "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": 229.92, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 229.92, "10th_percentile": 229.92, "90th_percentile": 229.92, "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": 140.2, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 140.2, "10th_percentile": 140.2, "90th_percentile": 140.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 280.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 46.54, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 46.54, "10th_percentile": 46.54, "90th_percentile": 46.54, "count": "0", "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": 132.9, "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": 132.9, "10th_percentile": 132.9, "90th_percentile": 132.9, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 127.58, "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": 127.58, "10th_percentile": 127.58, "90th_percentile": 127.58, "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": 147.77, "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": 147.77, "10th_percentile": 147.77, "90th_percentile": 147.77, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 280.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 58.88, "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": 58.88, "10th_percentile": 58.88, "90th_percentile": 58.88, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 179.17, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 179.17, "10th_percentile": 179.17, "90th_percentile": 179.17, "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": 120.57, "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": 120.57, "10th_percentile": 120.57, "90th_percentile": 120.57, "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": 252.35, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 252.35, "10th_percentile": 252.35, "90th_percentile": 252.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "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": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "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": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "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": 280.39, "10th_percentile": 280.39, "90th_percentile": 280.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BAG URINE DRAINAGE 154102", "code_information": [ { "code": "SUP-302799", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 4.13, "maximum": 24.88, "setting": "outpatient", "gross_charge": 24.88, "discounted_cash": 17.42, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 19.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 19.9, "10th_percentile": 19.9, "90th_percentile": 19.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 19.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 19.9, "10th_percentile": 19.9, "90th_percentile": 19.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 5.27, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5.27, "10th_percentile": 5.27, "90th_percentile": 5.27, "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 HMO", "standard_charge_dollar": 5.27, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5.27, "10th_percentile": 5.27, "90th_percentile": 5.27, "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": 6.79, "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": 6.79, "10th_percentile": 6.79, "90th_percentile": 6.79, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 6.79, "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": 6.79, "10th_percentile": 6.79, "90th_percentile": 6.79, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 24.88, "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 $24.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "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 $24.88 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": 5.48, "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": 5.48, "10th_percentile": 5.48, "90th_percentile": 5.48, "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 SELECT", "standard_charge_dollar": 5.21, "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": 5.21, "10th_percentile": 5.21, "90th_percentile": 5.21, "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": 5.79, "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": 5.79, "10th_percentile": 5.79, "90th_percentile": 5.79, "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": 11.2, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 12.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 12.44, "10th_percentile": 12.44, "90th_percentile": 12.44, "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", "standard_charge_dollar": 10.7, "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": 10.7, "10th_percentile": 10.7, "90th_percentile": 10.7, "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": 4.13, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 4.13, "10th_percentile": 4.13, "90th_percentile": 4.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 22.39, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 22.39, "10th_percentile": 22.39, "90th_percentile": 22.39, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 15.9, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 15.9, "10th_percentile": 15.9, "90th_percentile": 15.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 20.4, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 20.4, "10th_percentile": 20.4, "90th_percentile": 20.4, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 12.09, "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": 12.09, "10th_percentile": 12.09, "90th_percentile": 12.09, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 11.79, "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": 11.79, "10th_percentile": 11.79, "90th_percentile": 11.79, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 24.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 15.98, "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": 15.98, "10th_percentile": 15.98, "90th_percentile": 15.98, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 24.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 5.22, "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": 5.22, "10th_percentile": 5.22, "90th_percentile": 5.22, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 11.32, "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": 11.32, "10th_percentile": 11.32, "90th_percentile": 11.32, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 13.11, "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": 13.11, "10th_percentile": 13.11, "90th_percentile": 13.11, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "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": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "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": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "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": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BALANCED SALT SOLN NO.1 IRRIG. IO SOLN", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "RX-94533", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00065-0800-94", "type": "NDC" } ], "standard_charges": [ { "minimum": 92.38, "maximum": 556.5, "setting": "outpatient", "gross_charge": 556.5, "discounted_cash": 389.55, "payers_information": [ { "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": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "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": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "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": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "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": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "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": 445.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 445.2, "10th_percentile": 445.2, "90th_percentile": 445.2, "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": 445.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 445.2, "10th_percentile": 445.2, "90th_percentile": 445.2, "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": 117.92, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 117.92, "10th_percentile": 117.92, "90th_percentile": 117.92, "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 HMO", "standard_charge_dollar": 117.92, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 117.92, "10th_percentile": 117.92, "90th_percentile": 117.92, "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": 151.98, "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": 151.98, "10th_percentile": 151.98, "90th_percentile": 151.98, "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 PPO", "standard_charge_dollar": 151.98, "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": 151.98, "10th_percentile": 151.98, "90th_percentile": 151.98, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 556.5, "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 $556.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "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 $556.50 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 SELECT", "standard_charge_dollar": 116.64, "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": 116.64, "10th_percentile": 116.64, "90th_percentile": 116.64, "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 PREFERRED", "standard_charge_dollar": 122.49, "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": 122.49, "10th_percentile": 122.49, "90th_percentile": 122.49, "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": 129.5, "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": 129.5, "10th_percentile": 129.5, "90th_percentile": 129.5, "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": 250.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 250.43, "10th_percentile": 250.43, "90th_percentile": 250.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 355.6, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 355.6, "10th_percentile": 355.6, "90th_percentile": 355.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 456.33, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 456.33, "10th_percentile": 456.33, "90th_percentile": 456.33, "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 NM EMPLOYEES", "standard_charge_dollar": 92.38, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 92.38, "10th_percentile": 92.38, "90th_percentile": 92.38, "count": "0", "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": 357.44, "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": 357.44, "10th_percentile": 357.44, "90th_percentile": 357.44, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 556.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 270.46, "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": 270.46, "10th_percentile": 270.46, "90th_percentile": 270.46, "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": 500.85, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 500.85, "10th_percentile": 500.85, "90th_percentile": 500.85, "count": "0", "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": 116.87, "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": 116.87, "10th_percentile": 116.87, "90th_percentile": 116.87, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 278.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 278.25, "10th_percentile": 278.25, "90th_percentile": 278.25, "count": "0", "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": 263.78, "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": 263.78, "10th_percentile": 263.78, "90th_percentile": 263.78, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 293.28, "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": 293.28, "10th_percentile": 293.28, "90th_percentile": 293.28, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 556.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 556.5, "10th_percentile": 556.5, "90th_percentile": 556.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 253.21, "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": 253.21, "10th_percentile": 253.21, "90th_percentile": 253.21, "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": 239.3, "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": 239.3, "10th_percentile": 239.3, "90th_percentile": 239.3, "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." } ] } ] }, { "description": "BALLN R2P METACROSS RX PTA 035 200CM 6FR 5X100MM", "code_information": [ { "code": "SUP-391154", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 436.68, "maximum": 2630.58, "setting": "outpatient", "gross_charge": 2630.58, "discounted_cash": 1841.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1386.32, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price", "median_amount": 336.71, "10th_percentile": 336.71, "90th_percentile": 336.71, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price" }, { "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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 SELECT", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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 HMO", "standard_charge_dollar": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "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": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1315.29, "10th_percentile": 1315.29, "90th_percentile": 1315.29, "count": "0", "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": 2630.58, "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 $2,630.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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 $2,630.58 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1246.89, "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": 1246.89, "10th_percentile": 1246.89, "90th_percentile": 1246.89, "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": 552.42, "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": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2367.52, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2367.52, "10th_percentile": 2367.52, "90th_percentile": 2367.52, "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": 1196.91, "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": 1196.91, "10th_percentile": 1196.91, "90th_percentile": 1196.91, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2157.08, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 2157.08, "10th_percentile": 2157.08, "90th_percentile": 2157.08, "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 $19,355 CASE RATE" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1689.62, "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": 1689.62, "10th_percentile": 1689.62, "90th_percentile": 1689.62, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1183.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1183.76, "10th_percentile": 1183.76, "90th_percentile": 1183.76, "count": "0", "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": 1278.46, "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": 1278.46, "10th_percentile": 1278.46, "90th_percentile": 1278.46, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1131.15, "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": 1131.15, "10th_percentile": 1131.15, "90th_percentile": 1131.15, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 436.68, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 436.68, "10th_percentile": 436.68, "90th_percentile": 436.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1680.94, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1680.94, "10th_percentile": 1680.94, "90th_percentile": 1680.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" } ] } ] }, { "description": "BALLN R2P METACROSS RX PTA 035 200CM 6FR 5X40MM", "code_information": [ { "code": "SUP-391153", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 436.68, "maximum": 2630.58, "setting": "outpatient", "gross_charge": 2630.58, "discounted_cash": 1841.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1386.32, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price", "median_amount": 336.71, "10th_percentile": 336.71, "90th_percentile": 336.71, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price" }, { "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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 SELECT", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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 HMO", "standard_charge_dollar": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "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": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1315.29, "10th_percentile": 1315.29, "90th_percentile": 1315.29, "count": "0", "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": 2630.58, "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 $2,630.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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 $2,630.58 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1246.89, "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": 1246.89, "10th_percentile": 1246.89, "90th_percentile": 1246.89, "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": 552.42, "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": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2367.52, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2367.52, "10th_percentile": 2367.52, "90th_percentile": 2367.52, "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": 1196.91, "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": 1196.91, "10th_percentile": 1196.91, "90th_percentile": 1196.91, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2157.08, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 2157.08, "10th_percentile": 2157.08, "90th_percentile": 2157.08, "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 $19,355 CASE RATE" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1689.62, "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": 1689.62, "10th_percentile": 1689.62, "90th_percentile": 1689.62, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1183.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1183.76, "10th_percentile": 1183.76, "90th_percentile": 1183.76, "count": "0", "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": 1278.46, "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": 1278.46, "10th_percentile": 1278.46, "90th_percentile": 1278.46, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1131.15, "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": 1131.15, "10th_percentile": 1131.15, "90th_percentile": 1131.15, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 436.68, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 436.68, "10th_percentile": 436.68, "90th_percentile": 436.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1680.94, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1680.94, "10th_percentile": 1680.94, "90th_percentile": 1680.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" } ] } ] }, { "description": "BALLN R2P METACROSS RX PTA 035 200CM 6FR 6X100MM", "code_information": [ { "code": "SUP-391156", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 436.68, "maximum": 2630.58, "setting": "outpatient", "gross_charge": 2630.58, "discounted_cash": 1841.41, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1386.32, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price", "median_amount": 336.71, "10th_percentile": 336.71, "90th_percentile": 336.71, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $2,630.58 @ 12.8% = $336.71 due to $0.00 Claim Price" }, { "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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 SELECT", "standard_charge_dollar": 615.56, "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": 615.56, "10th_percentile": 615.56, "90th_percentile": 615.56, "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 HMO", "standard_charge_dollar": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "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": 2104.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2104.46, "10th_percentile": 2104.46, "90th_percentile": 2104.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1315.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1315.29, "10th_percentile": 1315.29, "90th_percentile": 1315.29, "count": "0", "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": 2630.58, "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 $2,630.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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 $2,630.58 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2630.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1246.89, "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": 1246.89, "10th_percentile": 1246.89, "90th_percentile": 1246.89, "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": 552.42, "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": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2367.52, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2367.52, "10th_percentile": 2367.52, "90th_percentile": 2367.52, "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": 2157.08, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 2157.08, "10th_percentile": 2157.08, "90th_percentile": 2157.08, "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 $19,355 CASE RATE" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1689.62, "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": 1689.62, "10th_percentile": 1689.62, "90th_percentile": 1689.62, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1183.76, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1183.76, "10th_percentile": 1183.76, "90th_percentile": 1183.76, "count": "0", "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": 1278.46, "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": 1278.46, "10th_percentile": 1278.46, "90th_percentile": 1278.46, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1680.94, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1680.94, "10th_percentile": 1680.94, "90th_percentile": 1680.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2630.58, "10th_percentile": 2630.58, "90th_percentile": 2630.58, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 718.15, "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": 718.15, "10th_percentile": 718.15, "90th_percentile": 718.15, "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 HMO", "standard_charge_dollar": 557.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 557.42, "10th_percentile": 557.42, "90th_percentile": 557.42, "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 ASA", "standard_charge_dollar": 1196.91, "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": 1196.91, "10th_percentile": 1196.91, "90th_percentile": 1196.91, "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 NM EMPLOYEES", "standard_charge_dollar": 436.68, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 436.68, "10th_percentile": 436.68, "90th_percentile": 436.68, "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", "standard_charge_dollar": 1131.15, "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": 1131.15, "10th_percentile": 1131.15, "90th_percentile": 1131.15, "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." } ] } ] }, { "description": "BALLOON ANGIO 5X60MM 135CM 0.035OTW DRG CTD STELLAREX", "code_information": [ { "code": "SUP-420103", "type": "CDM" }, { "code": "C2623", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1819.48, "maximum": 10960.75, "setting": "outpatient", "gross_charge": 10960.75, "discounted_cash": 7672.52, "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": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "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": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "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": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "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_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: $10,960.75 @ 12.8% = $1,402.98 due to $0.00 Claim Price", "median_amount": 1402.98, "10th_percentile": 1402.98, "90th_percentile": 1402.98, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $10,960.75 @ 12.8% = $1,402.98 due to $0.00 Claim Price" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 4713.12, "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": 4713.12, "10th_percentile": 4713.12, "90th_percentile": 4713.12, "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 ASA", "standard_charge_dollar": 4987.14, "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": 4987.14, "10th_percentile": 4987.14, "90th_percentile": 4987.14, "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 NM EMPLOYEES", "standard_charge_dollar": 1819.48, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1819.48, "10th_percentile": 1819.48, "90th_percentile": 1819.48, "count": "0", "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": 2322.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2322.58, "10th_percentile": 2322.58, "90th_percentile": 2322.58, "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": 2992.28, "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": 2992.28, "10th_percentile": 2992.28, "90th_percentile": 2992.28, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2301.76, "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": 2301.76, "10th_percentile": 2301.76, "90th_percentile": 2301.76, "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": 5326.92, "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": 5326.92, "10th_percentile": 5326.92, "90th_percentile": 5326.92, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 8987.82, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 8987.82, "10th_percentile": 8987.82, "90th_percentile": 8987.82, "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 $19,355 CASE RATE" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 7003.92, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 7003.92, "10th_percentile": 7003.92, "90th_percentile": 7003.92, "count": "0", "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": 9864.68, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 9864.68, "10th_percentile": 9864.68, "90th_percentile": 9864.68, "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": 5480.38, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5480.38, "10th_percentile": 5480.38, "90th_percentile": 5480.38, "count": "0", "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": 7040.09, "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": 7040.09, "10th_percentile": 7040.09, "90th_percentile": 7040.09, "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": 5195.4, "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": 5195.4, "10th_percentile": 5195.4, "90th_percentile": 5195.4, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 5776.32, "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": 5776.32, "10th_percentile": 5776.32, "90th_percentile": 5776.32, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2322.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2322.58, "10th_percentile": 2322.58, "90th_percentile": 2322.58, "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": 2992.28, "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": 2992.28, "10th_percentile": 2992.28, "90th_percentile": 2992.28, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 10960.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 10960.75, "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 $10,960.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "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 $10,960.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10960.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 10960.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 10960.75, "10th_percentile": 10960.75, "90th_percentile": 10960.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 8768.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8768.6, "10th_percentile": 8768.6, "90th_percentile": 8768.6, "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": 8768.6, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8768.6, "10th_percentile": 8768.6, "90th_percentile": 8768.6, "count": "0", "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 PREFERRED", "standard_charge_dollar": 2564.82, "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": 2564.82, "10th_percentile": 2564.82, "90th_percentile": 2564.82, "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 SELECT", "standard_charge_dollar": 2564.82, "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": 2564.82, "10th_percentile": 2564.82, "90th_percentile": 2564.82, "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": 2564.82, "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": 2564.82, "10th_percentile": 2564.82, "90th_percentile": 2564.82, "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." } ] } ] }, { "description": "BALLOON CATHETER EVERCROSS 6 X 40 MM .035 X 80 CM OTW", "code_information": [ { "code": "SUP-306729", "type": "CDM" }, { "code": "C1725", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 93.16, "maximum": 561.19, "setting": "outpatient", "gross_charge": 561.19, "discounted_cash": 392.83, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 295.75, "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": 385.64, "10th_percentile": 385.64, "90th_percentile": 385.64, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 561.19, "10th_percentile": 561.19, "90th_percentile": 561.19, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 561.19, "10th_percentile": 561.19, "90th_percentile": 561.19, "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": 561.19, "10th_percentile": 561.19, "90th_percentile": 561.19, "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": 561.19, "10th_percentile": 561.19, "90th_percentile": 561.19, "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_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: $561.19 @ 12.8% = $71.83 due to $0.00 Claim Price", "median_amount": 71.83, "10th_percentile": 71.83, "90th_percentile": 71.83, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $561.19 @ 12.8% = $71.83 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 131.32, "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": 131.32, "10th_percentile": 131.32, "90th_percentile": 131.32, "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": 131.32, "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": 131.32, "10th_percentile": 131.32, "90th_percentile": 131.32, "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 SELECT", "standard_charge_dollar": 131.32, "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": 131.32, "10th_percentile": 131.32, "90th_percentile": 131.32, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 153.2, "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": 153.2, "10th_percentile": 153.2, "90th_percentile": 153.2, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 153.2, "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": 153.2, "10th_percentile": 153.2, "90th_percentile": 153.2, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 448.95, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 448.95, "10th_percentile": 448.95, "90th_percentile": 448.95, "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": 448.95, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 448.95, "10th_percentile": 448.95, "90th_percentile": 448.95, "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": 118.92, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 118.92, "10th_percentile": 118.92, "90th_percentile": 118.92, "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 HMO", "standard_charge_dollar": 118.92, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 118.92, "10th_percentile": 118.92, "90th_percentile": 118.92, "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": 266.0, "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": 266.0, "10th_percentile": 266.0, "90th_percentile": 266.0, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 360.45, "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": 360.45, "10th_percentile": 360.45, "90th_percentile": 360.45, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 93.16, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 93.16, "10th_percentile": 93.16, "90th_percentile": 93.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 505.07, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 505.07, "10th_percentile": 505.07, "90th_percentile": 505.07, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 358.6, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 358.6, "10th_percentile": 358.6, "90th_percentile": 358.6, "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 ASA", "standard_charge_dollar": 255.34, "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": 255.34, "10th_percentile": 255.34, "90th_percentile": 255.34, "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": 241.31, "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": 241.31, "10th_percentile": 241.31, "90th_percentile": 241.31, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 252.54, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 280.6, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 460.18, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 460.18, "10th_percentile": 460.18, "90th_percentile": 460.18, "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 $19,355 CASE RATE" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 272.74, "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": 272.74, "10th_percentile": 272.74, "90th_percentile": 272.74, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 117.85, "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": 117.85, "10th_percentile": 117.85, "90th_percentile": 117.85, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 561.19, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 561.19, "10th_percentile": 561.19, "90th_percentile": 561.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 561.19, "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 $561.19 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 561.19, "10th_percentile": 561.19, "90th_percentile": 561.19, "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 $561.19 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 561.19, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 561.19, "10th_percentile": 561.19, "90th_percentile": 561.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" } ] } ] }, { "description": "BALLOON ENDOCAVITY 2X14CM NONSTRL", "code_information": [ { "code": "SUP-319743", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 41.92, "maximum": 252.54, "setting": "outpatient", "gross_charge": 252.54, "discounted_cash": 176.78, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 202.03, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 202.03, "10th_percentile": 202.03, "90th_percentile": 202.03, "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": 202.03, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 202.03, "10th_percentile": 202.03, "90th_percentile": 202.03, "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 HMO", "standard_charge_dollar": 53.51, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 53.51, "10th_percentile": 53.51, "90th_percentile": 53.51, "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 HMO", "standard_charge_dollar": 53.51, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 53.51, "10th_percentile": 53.51, "90th_percentile": 53.51, "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": 68.97, "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": 68.97, "10th_percentile": 68.97, "90th_percentile": 68.97, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 68.97, "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": 68.97, "10th_percentile": 68.97, "90th_percentile": 68.97, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 252.54, "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 $252.54 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "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 $252.54 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": 55.58, "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": 55.58, "10th_percentile": 55.58, "90th_percentile": 55.58, "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": 52.93, "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": 52.93, "10th_percentile": 52.93, "90th_percentile": 52.93, "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": 58.77, "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": 58.77, "10th_percentile": 58.77, "90th_percentile": 58.77, "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": 113.64, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 113.64, "10th_percentile": 113.64, "90th_percentile": 113.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 126.27, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 126.27, "10th_percentile": 126.27, "90th_percentile": 126.27, "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", "standard_charge_dollar": 108.59, "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": 108.59, "10th_percentile": 108.59, "90th_percentile": 108.59, "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": 41.92, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 41.92, "10th_percentile": 41.92, "90th_percentile": 41.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 227.29, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 227.29, "10th_percentile": 227.29, "90th_percentile": 227.29, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 161.37, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 161.37, "10th_percentile": 161.37, "90th_percentile": 161.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 207.08, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 207.08, "10th_percentile": 207.08, "90th_percentile": 207.08, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 122.73, "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": 122.73, "10th_percentile": 122.73, "90th_percentile": 122.73, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 119.7, "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": 119.7, "10th_percentile": 119.7, "90th_percentile": 119.7, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 252.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 162.21, "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": 162.21, "10th_percentile": 162.21, "90th_percentile": 162.21, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 252.54, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 53.03, "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": 53.03, "10th_percentile": 53.03, "90th_percentile": 53.03, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 114.91, "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": 114.91, "10th_percentile": 114.91, "90th_percentile": 114.91, "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": 133.09, "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": 133.09, "10th_percentile": 133.09, "90th_percentile": 133.09, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "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": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "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": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "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": 252.54, "10th_percentile": 252.54, "90th_percentile": 252.54, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BALLOON IN.PACT AV DCB 9MMX80MMX130CM 7F", "code_information": [ { "code": "SUP-402361", "type": "CDM" }, { "code": "C2623", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 2256.16, "maximum": 13591.33, "setting": "outpatient", "gross_charge": 13591.33, "discounted_cash": 9513.93, "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": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "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": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "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": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "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_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: $13,591.33 @ 12.8% = $1,739.69 due to $0.00 Claim Price", "median_amount": 1739.69, "10th_percentile": 1739.69, "90th_percentile": 1739.69, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $13,591.33 @ 12.8% = $1,739.69 due to $0.00 Claim Price" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 13591.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 13591.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 13591.33, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "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": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 13591.33, "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 $13,591.33 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 13591.33, "10th_percentile": 13591.33, "90th_percentile": 13591.33, "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 $13,591.33 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2880.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2880.0, "10th_percentile": 2880.0, "90th_percentile": 2880.0, "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 HMO", "standard_charge_dollar": 2880.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2880.0, "10th_percentile": 2880.0, "90th_percentile": 2880.0, "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": 3710.43, "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": 3710.43, "10th_percentile": 3710.43, "90th_percentile": 3710.43, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 3710.43, "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": 3710.43, "10th_percentile": 3710.43, "90th_percentile": 3710.43, "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", "standard_charge_dollar": 5844.27, "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": 5844.27, "10th_percentile": 5844.27, "90th_percentile": 5844.27, "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 ASA", "standard_charge_dollar": 6184.06, "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": 6184.06, "10th_percentile": 6184.06, "90th_percentile": 6184.06, "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 NM EMPLOYEES", "standard_charge_dollar": 2256.16, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 2256.16, "10th_percentile": 2256.16, "90th_percentile": 2256.16, "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 ALTERNATIVE", "standard_charge_dollar": 2854.18, "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": 2854.18, "10th_percentile": 2854.18, "90th_percentile": 2854.18, "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": 6605.39, "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": 6605.39, "10th_percentile": 6605.39, "90th_percentile": 6605.39, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 11144.89, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 11144.89, "10th_percentile": 11144.89, "90th_percentile": 11144.89, "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 $19,355 CASE RATE" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 8684.86, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 8684.86, "10th_percentile": 8684.86, "90th_percentile": 8684.86, "count": "0", "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": 12232.2, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 12232.2, "10th_percentile": 12232.2, "90th_percentile": 12232.2, "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": 6795.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "count": "0", "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": 8729.71, "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": 8729.71, "10th_percentile": 8729.71, "90th_percentile": 8729.71, "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": 6442.29, "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": 6442.29, "10th_percentile": 6442.29, "90th_percentile": 6442.29, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 7162.63, "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": 7162.63, "10th_percentile": 7162.63, "90th_percentile": 7162.63, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 10873.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10873.06, "10th_percentile": 10873.06, "90th_percentile": 10873.06, "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": 10873.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10873.06, "10th_percentile": 10873.06, "90th_percentile": 10873.06, "count": "0", "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 PREFERRED", "standard_charge_dollar": 3180.37, "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": 3180.37, "10th_percentile": 3180.37, "90th_percentile": 3180.37, "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 SELECT", "standard_charge_dollar": 3180.37, "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": 3180.37, "10th_percentile": 3180.37, "90th_percentile": 3180.37, "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": 3180.37, "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": 3180.37, "10th_percentile": 3180.37, "90th_percentile": 3180.37, "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." } ] } ] }, { "description": "BAND ANNULPLSY W. HLDR FLXFRM SZ 30", "code_information": [ { "code": "SUP-337835", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 3013.07, "maximum": 18151.0, "setting": "outpatient", "gross_charge": 18151.0, "discounted_cash": 12705.7, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 3013.07, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4247.33, "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": 4247.33, "10th_percentile": 4247.33, "90th_percentile": 4247.33, "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": 4247.33, "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": 4247.33, "10th_percentile": 4247.33, "90th_percentile": 4247.33, "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 SELECT", "standard_charge_dollar": 4247.33, "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": 4247.33, "10th_percentile": 4247.33, "90th_percentile": 4247.33, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 9075.5, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 9075.5, "10th_percentile": 9075.5, "90th_percentile": 9075.5, "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 ASA", "standard_charge_dollar": 8258.71, "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": 8258.71, "10th_percentile": 8258.71, "90th_percentile": 8258.71, "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": 9565.58, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 3811.71, "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": 3811.71, "10th_percentile": 3811.71, "90th_percentile": 3811.71, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 13976.27, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 13976.27, "10th_percentile": 13976.27, "90th_percentile": 13976.27, "count": "0", "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": 16335.9, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 16335.9, "10th_percentile": 16335.9, "90th_percentile": 16335.9, "count": "0", "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": 8821.39, "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": 8821.39, "10th_percentile": 8821.39, "90th_percentile": 8821.39, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 8167.95, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 8167.95, "10th_percentile": 8167.95, "90th_percentile": 8167.95, "count": "0", "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": 11658.39, "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": 11658.39, "10th_percentile": 11658.39, "90th_percentile": 11658.39, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 11598.49, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 11598.49, "10th_percentile": 11598.49, "90th_percentile": 11598.49, "count": "0", "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": 8603.57, "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": 8603.57, "10th_percentile": 8603.57, "90th_percentile": 8603.57, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 7804.93, "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": 7804.93, "10th_percentile": 7804.93, "90th_percentile": 7804.93, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 18151.0, "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 $18,151.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 18151.0, "10th_percentile": 18151.0, "90th_percentile": 18151.0, "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 $18,151.00 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 18151.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 18151.0, "10th_percentile": 18151.0, "90th_percentile": 18151.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18151.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18151.0, "10th_percentile": 18151.0, "90th_percentile": 18151.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 14520.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14520.8, "10th_percentile": 14520.8, "90th_percentile": 14520.8, "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": 14520.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14520.8, "10th_percentile": 14520.8, "90th_percentile": 14520.8, "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 HMO", "standard_charge_dollar": 3846.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3846.2, "10th_percentile": 3846.2, "90th_percentile": 3846.2, "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 HMO", "standard_charge_dollar": 3846.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3846.2, "10th_percentile": 3846.2, "90th_percentile": 3846.2, "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": 4955.22, "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": 4955.22, "10th_percentile": 4955.22, "90th_percentile": 4955.22, "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": 4955.22, "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": 4955.22, "10th_percentile": 4955.22, "90th_percentile": 4955.22, "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 MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18151.0, "10th_percentile": 18151.0, "90th_percentile": 18151.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18151.0, "10th_percentile": 18151.0, "90th_percentile": 18151.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18151.0, "10th_percentile": 18151.0, "90th_percentile": 18151.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18151.0, "10th_percentile": 18151.0, "90th_percentile": 18151.0, "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_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: $18,151.00 @ 12.8% = $2,323.33 due to $0.00 Claim Price", "median_amount": 2323.33, "10th_percentile": 2323.33, "90th_percentile": 2323.33, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $18,151.00 @ 12.8% = $2,323.33 due to $0.00 Claim Price" } ] } ] }, { "description": "BAND GSTROSPHGEL SPHIN MAG TI BEAD LNX SZ 12", "code_information": [ { "code": "SUP-143320", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 6649.95, "maximum": 40059.95, "setting": "outpatient", "gross_charge": 40059.95, "discounted_cash": 28041.96, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 6649.95, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 18227.28, "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": 18227.28, "10th_percentile": 18227.28, "90th_percentile": 18227.28, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 18026.98, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 18026.98, "10th_percentile": 18026.98, "90th_percentile": 18026.98, "count": "0", "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": 17225.78, "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": 17225.78, "10th_percentile": 17225.78, "90th_percentile": 17225.78, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 40059.95, "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 $40,059.95 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 40059.95, "10th_percentile": 40059.95, "90th_percentile": 40059.95, "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 $40,059.95 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 32047.96, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 32047.96, "10th_percentile": 32047.96, "90th_percentile": 32047.96, "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": 10936.37, "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": 10936.37, "10th_percentile": 10936.37, "90th_percentile": 10936.37, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 10936.37, "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": 10936.37, "10th_percentile": 10936.37, "90th_percentile": 10936.37, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 8488.7, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 8488.7, "10th_percentile": 8488.7, "90th_percentile": 8488.7, "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": 8488.7, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 8488.7, "10th_percentile": 8488.7, "90th_percentile": 8488.7, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 9374.03, "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": 9374.03, "10th_percentile": 9374.03, "90th_percentile": 9374.03, "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": 9374.03, "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": 9374.03, "10th_percentile": 9374.03, "90th_percentile": 9374.03, "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 SELECT", "standard_charge_dollar": 9374.03, "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": 9374.03, "10th_percentile": 9374.03, "90th_percentile": 9374.03, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 40059.95, "10th_percentile": 40059.95, "90th_percentile": 40059.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 40059.95, "10th_percentile": 40059.95, "90th_percentile": 40059.95, "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": 40059.95, "10th_percentile": 40059.95, "90th_percentile": 40059.95, "count": "0", "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": 20029.98, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 20029.98, "10th_percentile": 20029.98, "90th_percentile": 20029.98, "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": 21111.59, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 8412.59, "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": 8412.59, "10th_percentile": 8412.59, "90th_percentile": 8412.59, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 30846.16, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 30846.16, "10th_percentile": 30846.16, "90th_percentile": 30846.16, "count": "0", "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": 36053.96, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 36053.96, "10th_percentile": 36053.96, "90th_percentile": 36053.96, "count": "0", "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": 19469.14, "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": 19469.14, "10th_percentile": 19469.14, "90th_percentile": 19469.14, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 25730.51, "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": 25730.51, "10th_percentile": 25730.51, "90th_percentile": 25730.51, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 25598.31, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 25598.31, "10th_percentile": 25598.31, "90th_percentile": 25598.31, "count": "0", "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": 18988.42, "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": 18988.42, "10th_percentile": 18988.42, "90th_percentile": 18988.42, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 40059.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 40059.95, "10th_percentile": 40059.95, "90th_percentile": 40059.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 40059.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40059.95, "10th_percentile": 40059.95, "90th_percentile": 40059.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 32047.96, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 32047.96, "10th_percentile": 32047.96, "90th_percentile": 32047.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "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": 40059.95, "10th_percentile": 40059.95, "90th_percentile": 40059.95, "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_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: $40,059.95 @ 12.8% = $5,127.67 due to $0.00 Claim Price", "median_amount": 5127.67, "10th_percentile": 5127.67, "90th_percentile": 5127.67, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $40,059.95 @ 12.8% = $5,127.67 due to $0.00 Claim Price" } ] } ] }, { "description": "BANDAGE D STAT HEMOSTATIC", "code_information": [ { "code": "SUP-321553", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 58.52, "maximum": 352.5, "setting": "outpatient", "gross_charge": 352.5, "discounted_cash": 246.75, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 96.27, "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": 96.27, "10th_percentile": 96.27, "90th_percentile": 96.27, "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 HMO", "standard_charge_dollar": 74.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 74.69, "10th_percentile": 74.69, "90th_percentile": 74.69, "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": 282.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 282.0, "10th_percentile": 282.0, "90th_percentile": 282.0, "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": 282.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 282.0, "10th_percentile": 282.0, "90th_percentile": 282.0, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 352.5, "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 $352.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "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 $352.50 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 OPTIONS", "standard_charge_dollar": 82.03, "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": 82.03, "10th_percentile": 82.03, "90th_percentile": 82.03, "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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 77.59, "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": 77.59, "10th_percentile": 77.59, "90th_percentile": 77.59, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 158.63, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 158.63, "10th_percentile": 158.63, "90th_percentile": 158.63, "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": 73.88, "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": 73.88, "10th_percentile": 73.88, "90th_percentile": 73.88, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 317.25, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 317.25, "10th_percentile": 317.25, "90th_percentile": 317.25, "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": 176.25, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 176.25, "10th_percentile": 176.25, "90th_percentile": 176.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 289.05, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 289.05, "10th_percentile": 289.05, "90th_percentile": 289.05, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 171.32, "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": 171.32, "10th_percentile": 171.32, "90th_percentile": 171.32, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 352.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 225.25, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 225.25, "10th_percentile": 225.25, "90th_percentile": 225.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 352.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 226.41, "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": 226.41, "10th_percentile": 226.41, "90th_percentile": 226.41, "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": 185.77, "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": 185.77, "10th_percentile": 185.77, "90th_percentile": 185.77, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 167.09, "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": 167.09, "10th_percentile": 167.09, "90th_percentile": 167.09, "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": 74.03, "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": 74.03, "10th_percentile": 74.03, "90th_percentile": 74.03, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "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": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "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": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 74.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 74.69, "10th_percentile": 74.69, "90th_percentile": 74.69, "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": 96.27, "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": 96.27, "10th_percentile": 96.27, "90th_percentile": 96.27, "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", "standard_charge_dollar": 151.58, "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": 151.58, "10th_percentile": 151.58, "90th_percentile": 151.58, "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": 58.52, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "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 ASA", "standard_charge_dollar": 160.39, "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": 160.39, "10th_percentile": 160.39, "90th_percentile": 160.39, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "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": 352.5, "10th_percentile": 352.5, "90th_percentile": 352.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BANDAGE FOAM COFLEX LF2 4IN 5YD TAN STERILE", "code_information": [ { "code": "SUP-416682", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 10.97, "maximum": 66.09, "setting": "outpatient", "gross_charge": 66.09, "discounted_cash": 46.26, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 18.05, "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": 18.05, "10th_percentile": 18.05, "90th_percentile": 18.05, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 18.05, "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": 18.05, "10th_percentile": 18.05, "90th_percentile": 18.05, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 14.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "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 HMO", "standard_charge_dollar": 14.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 14.0, "10th_percentile": 14.0, "90th_percentile": 14.0, "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": 52.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 52.87, "10th_percentile": 52.87, "90th_percentile": 52.87, "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": 52.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 52.87, "10th_percentile": 52.87, "90th_percentile": 52.87, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 66.09, "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 $66.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "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 $66.09 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": 15.38, "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": 15.38, "10th_percentile": 15.38, "90th_percentile": 15.38, "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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 14.55, "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": 14.55, "10th_percentile": 14.55, "90th_percentile": 14.55, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 29.74, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 29.74, "10th_percentile": 29.74, "90th_percentile": 29.74, "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": 13.85, "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": 13.85, "10th_percentile": 13.85, "90th_percentile": 13.85, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 59.48, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 59.48, "10th_percentile": 59.48, "90th_percentile": 59.48, "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": 33.05, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 33.05, "10th_percentile": 33.05, "90th_percentile": 33.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 54.19, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 54.19, "10th_percentile": 54.19, "90th_percentile": 54.19, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 32.12, "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": 32.12, "10th_percentile": 32.12, "90th_percentile": 32.12, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 66.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 42.23, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 42.23, "10th_percentile": 42.23, "90th_percentile": 42.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 10.97, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 10.97, "10th_percentile": 10.97, "90th_percentile": 10.97, "count": "0", "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": 42.45, "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": 42.45, "10th_percentile": 42.45, "90th_percentile": 42.45, "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": 34.83, "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": 34.83, "10th_percentile": 34.83, "90th_percentile": 34.83, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 31.33, "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": 31.33, "10th_percentile": 31.33, "90th_percentile": 31.33, "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": 13.88, "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": 13.88, "10th_percentile": 13.88, "90th_percentile": 13.88, "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": 28.42, "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": 28.42, "10th_percentile": 28.42, "90th_percentile": 28.42, "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 ASA", "standard_charge_dollar": 30.07, "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": 30.07, "10th_percentile": 30.07, "90th_percentile": 30.07, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "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": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "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": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "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": 66.09, "10th_percentile": 66.09, "90th_percentile": 66.09, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BAR CHST SZ14.5 RMDLNG PCTS BLU", "code_information": [ { "code": "SUP-433751", "type": "CDM" }, { "code": "C1889", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 7248.83, "maximum": 43667.63, "setting": "outpatient", "gross_charge": 43667.63, "discounted_cash": 30567.34, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 7248.83, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 55.37, "10th_percentile": 55.37, "90th_percentile": 55.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 10218.23, "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": 10218.23, "10th_percentile": 10218.23, "90th_percentile": 10218.23, "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": 10218.23, "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": 10218.23, "10th_percentile": 10218.23, "90th_percentile": 10218.23, "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 SELECT", "standard_charge_dollar": 10218.23, "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": 10218.23, "10th_percentile": 10218.23, "90th_percentile": 10218.23, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 21833.82, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 21833.82, "10th_percentile": 21833.82, "90th_percentile": 21833.82, "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 ASA", "standard_charge_dollar": 19868.77, "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": 19868.77, "10th_percentile": 19868.77, "90th_percentile": 19868.77, "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": 23012.84, "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": 1959.75, "10th_percentile": 1959.75, "90th_percentile": 1959.75, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 9170.2, "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": 9170.2, "10th_percentile": 9170.2, "90th_percentile": 9170.2, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 33624.08, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 33624.08, "10th_percentile": 33624.08, "90th_percentile": 33624.08, "count": "0", "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": 39300.87, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 39300.87, "10th_percentile": 39300.87, "90th_percentile": 39300.87, "count": "0", "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": 21222.47, "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": 21222.47, "10th_percentile": 21222.47, "90th_percentile": 21222.47, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 19650.43, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 19650.43, "10th_percentile": 19650.43, "90th_percentile": 19650.43, "count": "0", "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": 28047.72, "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": 28047.72, "10th_percentile": 28047.72, "90th_percentile": 28047.72, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 27903.62, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 27903.62, "10th_percentile": 27903.62, "90th_percentile": 27903.62, "count": "0", "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": 20698.46, "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": 20698.46, "10th_percentile": 20698.46, "90th_percentile": 20698.46, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 18777.08, "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": 18777.08, "10th_percentile": 18777.08, "90th_percentile": 18777.08, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 43667.63, "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 $43,667.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 43667.63, "10th_percentile": 43667.63, "90th_percentile": 43667.63, "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 $43,667.63 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 43667.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 43667.63, "10th_percentile": 43667.63, "90th_percentile": 43667.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 43667.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 43667.63, "10th_percentile": 43667.63, "90th_percentile": 43667.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 34934.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 34934.1, "10th_percentile": 34934.1, "90th_percentile": 34934.1, "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": 34934.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 34934.1, "10th_percentile": 34934.1, "90th_percentile": 34934.1, "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": 9253.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 9253.17, "10th_percentile": 9253.17, "90th_percentile": 9253.17, "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 HMO", "standard_charge_dollar": 9253.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 9253.17, "10th_percentile": 9253.17, "90th_percentile": 9253.17, "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": 11921.26, "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": 11921.26, "10th_percentile": 11921.26, "90th_percentile": 11921.26, "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": 11921.26, "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": 11921.26, "10th_percentile": 11921.26, "90th_percentile": 11921.26, "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 MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 43667.63, "10th_percentile": 43667.63, "90th_percentile": 43667.63, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 43667.63, "10th_percentile": 43667.63, "90th_percentile": 43667.63, "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": 43667.63, "10th_percentile": 43667.63, "90th_percentile": 43667.63, "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": 43667.63, "10th_percentile": 43667.63, "90th_percentile": 43667.63, "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_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: $43,667.63 @ 12.8% = $5,589.46 due to $0.00 Claim Price", "median_amount": 5589.46, "10th_percentile": 5589.46, "90th_percentile": 5589.46, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $43,667.63 @ 12.8% = $5,589.46 due to $0.00 Claim Price" } ] } ] }, { "description": "BARD EAGLE INFLATION DEVICE 10CC (325110)", "code_information": [ { "code": "SUP-302854", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 117.15, "maximum": 705.7, "setting": "outpatient", "gross_charge": 705.7, "discounted_cash": 493.99, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 564.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 564.56, "10th_percentile": 564.56, "90th_percentile": 564.56, "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": 564.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 564.56, "10th_percentile": 564.56, "90th_percentile": 564.56, "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": 149.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 149.54, "10th_percentile": 149.54, "90th_percentile": 149.54, "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 HMO", "standard_charge_dollar": 149.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 149.54, "10th_percentile": 149.54, "90th_percentile": 149.54, "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": 192.73, "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": 192.73, "10th_percentile": 192.73, "90th_percentile": 192.73, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 192.73, "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": 192.73, "10th_percentile": 192.73, "90th_percentile": 192.73, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 705.7, "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 $705.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "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 $705.70 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": 155.32, "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": 155.32, "10th_percentile": 155.32, "90th_percentile": 155.32, "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 SELECT", "standard_charge_dollar": 147.91, "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": 147.91, "10th_percentile": 147.91, "90th_percentile": 147.91, "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": 164.22, "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": 164.22, "10th_percentile": 164.22, "90th_percentile": 164.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 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": 317.57, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 317.57, "10th_percentile": 317.57, "90th_percentile": 317.57, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 352.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 352.85, "10th_percentile": 352.85, "90th_percentile": 352.85, "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", "standard_charge_dollar": 303.45, "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": 303.45, "10th_percentile": 303.45, "90th_percentile": 303.45, "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": 117.15, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 117.15, "10th_percentile": 117.15, "90th_percentile": 117.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 635.13, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 635.13, "10th_percentile": 635.13, "90th_percentile": 635.13, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 450.94, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 450.94, "10th_percentile": 450.94, "90th_percentile": 450.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 578.67, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 578.67, "10th_percentile": 578.67, "90th_percentile": 578.67, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 342.97, "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": 342.97, "10th_percentile": 342.97, "90th_percentile": 342.97, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 334.5, "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": 334.5, "10th_percentile": 334.5, "90th_percentile": 334.5, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 705.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 453.27, "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": 453.27, "10th_percentile": 453.27, "90th_percentile": 453.27, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 705.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 148.2, "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": 148.2, "10th_percentile": 148.2, "90th_percentile": 148.2, "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 ASA", "standard_charge_dollar": 321.09, "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": 321.09, "10th_percentile": 321.09, "90th_percentile": 321.09, "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": 371.9, "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": 371.9, "10th_percentile": 371.9, "90th_percentile": 371.9, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "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": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "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": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "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": 705.7, "10th_percentile": 705.7, "90th_percentile": 705.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BARD VIKING DIAG CS DECAPOLAR CATH FIXED CURVE 6FR", "code_information": [ { "code": "SUP-120964", "type": "CDM" }, { "code": "C1730", "type": "HCPCS" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 247.45, "maximum": 1490.66, "setting": "outpatient", "gross_charge": 1490.66, "discounted_cash": 1043.46, "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": 1490.66, "10th_percentile": 1490.66, "90th_percentile": 1490.66, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1490.66, "10th_percentile": 1490.66, "90th_percentile": 1490.66, "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": 1490.66, "10th_percentile": 1490.66, "90th_percentile": 1490.66, "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": 1490.66, "10th_percentile": 1490.66, "90th_percentile": 1490.66, "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_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: $1,490.66 @ 12.8% = $190.80 due to $0.00 Claim Price", "median_amount": 190.8, "10th_percentile": 190.8, "90th_percentile": 190.8, "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: $1,490.66 @ 12.8% = $190.80 due to $0.00 Claim Price" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 670.8, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 670.8, "10th_percentile": 670.8, "90th_percentile": 670.8, "count": "0", "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": 1222.34, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 1222.34, "10th_percentile": 1222.34, "90th_percentile": 1222.34, "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 $19,355 CASE RATE" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 724.46, "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": 724.46, "10th_percentile": 724.46, "90th_percentile": 724.46, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 313.04, "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": 313.04, "10th_percentile": 313.04, "90th_percentile": 313.04, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 640.98, "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": 640.98, "10th_percentile": 640.98, "90th_percentile": 640.98, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 785.58, "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": 785.58, "10th_percentile": 785.58, "90th_percentile": 785.58, "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 NM EMPLOYEES", "standard_charge_dollar": 247.45, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 247.45, "10th_percentile": 247.45, "90th_percentile": 247.45, "count": "0", "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": 957.45, "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": 957.45, "10th_percentile": 957.45, "90th_percentile": 957.45, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1341.59, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1341.59, "10th_percentile": 1341.59, "90th_percentile": 1341.59, "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": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1490.66, "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 $1,490.66 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1490.66, "10th_percentile": 1490.66, "90th_percentile": 1490.66, "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 $1,490.66 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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1490.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1490.66, "10th_percentile": 1490.66, "90th_percentile": 1490.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1490.66, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1490.66, "10th_percentile": 1490.66, "90th_percentile": 1490.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 706.57, "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": 706.57, "10th_percentile": 706.57, "90th_percentile": 706.57, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 745.33, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 745.33, "10th_percentile": 745.33, "90th_percentile": 745.33, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 952.53, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 952.53, "10th_percentile": 952.53, "90th_percentile": 952.53, "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": 678.25, "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": 678.25, "10th_percentile": 678.25, "90th_percentile": 678.25, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 406.95, "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": 406.95, "10th_percentile": 406.95, "90th_percentile": 406.95, "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": 406.95, "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": 406.95, "10th_percentile": 406.95, "90th_percentile": 406.95, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 315.87, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 315.87, "10th_percentile": 315.87, "90th_percentile": 315.87, "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": 315.87, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 315.87, "10th_percentile": 315.87, "90th_percentile": 315.87, "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": 1192.53, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1192.53, "10th_percentile": 1192.53, "90th_percentile": 1192.53, "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": 1192.53, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1192.53, "10th_percentile": 1192.53, "90th_percentile": 1192.53, "count": "0", "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 PREFERRED", "standard_charge_dollar": 348.81, "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": 348.81, "10th_percentile": 348.81, "90th_percentile": 348.81, "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 SELECT", "standard_charge_dollar": 348.81, "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": 348.81, "10th_percentile": 348.81, "90th_percentile": 348.81, "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": 348.81, "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": 348.81, "10th_percentile": 348.81, "90th_percentile": 348.81, "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." } ] } ] }, { "description": "BARRIER OST SKN WIPE NO STNG CAVLON 1ML FOAM", "code_information": [ { "code": "SUP-368301", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 0.54, "maximum": 3.24, "setting": "outpatient", "gross_charge": 3.24, "discounted_cash": 2.27, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "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": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "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": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "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": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "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": 2.59, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.59, "10th_percentile": 2.59, "90th_percentile": 2.59, "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": 2.59, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2.59, "10th_percentile": 2.59, "90th_percentile": 2.59, "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": 0.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.69, "10th_percentile": 0.69, "90th_percentile": 0.69, "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 HMO", "standard_charge_dollar": 0.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 0.69, "10th_percentile": 0.69, "90th_percentile": 0.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 3.24, "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 $3.24 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3.24, "10th_percentile": 3.24, "90th_percentile": 3.24, "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 $3.24 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1.62, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1.62, "10th_percentile": 1.62, "90th_percentile": 1.62, "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": 2.92, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2.92, "10th_percentile": 2.92, "90th_percentile": 2.92, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2.07, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2.07, "10th_percentile": 2.07, "90th_percentile": 2.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1.46, "10th_percentile": 1.46, "90th_percentile": 1.46, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1.54, "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": 1.54, "10th_percentile": 1.54, "90th_percentile": 1.54, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 0.71, "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": 0.71, "10th_percentile": 0.71, "90th_percentile": 0.71, "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": 0.75, "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": 0.75, "10th_percentile": 0.75, "90th_percentile": 0.75, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2.08, "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": 2.08, "10th_percentile": 2.08, "90th_percentile": 2.08, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 0.54, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 0.54, "10th_percentile": 0.54, "90th_percentile": 0.54, "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 ALTERNATIVE", "standard_charge_dollar": 0.68, "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": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "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": 1.39, "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": 1.39, "10th_percentile": 1.39, "90th_percentile": 1.39, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 1.57, "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": 1.57, "10th_percentile": 1.57, "90th_percentile": 1.57, "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": 2.66, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2.66, "10th_percentile": 2.66, "90th_percentile": 2.66, "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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 0.68, "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": 0.68, "10th_percentile": 0.68, "90th_percentile": 0.68, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1.47, "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": 1.47, "10th_percentile": 1.47, "90th_percentile": 1.47, "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": 1.71, "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": 1.71, "10th_percentile": 1.71, "90th_percentile": 1.71, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.88, "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": 0.88, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 0.88, "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": 0.88, "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." } ] } ] }, { "description": "BASE TIB SZ 10 CEMENTED FX REV ATTUNE", "code_information": [ { "code": "SUP-421799", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 4305.59, "maximum": 25937.26, "setting": "outpatient", "gross_charge": 25937.26, "discounted_cash": 18156.08, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 4305.59, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $25,937.26 @ 12.8% = $3,319.97 due to $0.00 Claim Price", "median_amount": 3319.97, "10th_percentile": 3319.97, "90th_percentile": 3319.97, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $25,937.26 @ 12.8% = $3,319.97 due to $0.00 Claim Price" }, { "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": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "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": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "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": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "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 BCBS PPO", "standard_charge_dollar": 7080.87, "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": 7080.87, "10th_percentile": 7080.87, "90th_percentile": 7080.87, "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": 7080.87, "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": 7080.87, "10th_percentile": 7080.87, "90th_percentile": 7080.87, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 20749.81, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 20749.81, "10th_percentile": 20749.81, "90th_percentile": 20749.81, "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": 20749.81, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 20749.81, "10th_percentile": 20749.81, "90th_percentile": 20749.81, "count": "0", "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": 5496.11, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5496.11, "10th_percentile": 5496.11, "90th_percentile": 5496.11, "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": 5496.11, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5496.11, "10th_percentile": 5496.11, "90th_percentile": 5496.11, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 25937.26, "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 $25,937.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "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 $25,937.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25937.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 25937.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 25937.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 25937.26, "10th_percentile": 25937.26, "90th_percentile": 25937.26, "count": "0", "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": 13668.94, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 12294.26, "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": 12294.26, "10th_percentile": 12294.26, "90th_percentile": 12294.26, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 19971.69, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 19971.69, "10th_percentile": 19971.69, "90th_percentile": 19971.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 5446.82, "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": 5446.82, "10th_percentile": 5446.82, "90th_percentile": 5446.82, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 23343.53, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 23343.53, "10th_percentile": 23343.53, "90th_percentile": 23343.53, "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": 11801.45, "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": 11801.45, "10th_percentile": 11801.45, "90th_percentile": 11801.45, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 16659.5, "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": 16659.5, "10th_percentile": 16659.5, "90th_percentile": 16659.5, "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 BROAD", "standard_charge_dollar": 12605.51, "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": 12605.51, "10th_percentile": 12605.51, "90th_percentile": 12605.51, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 16573.91, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 16573.91, "10th_percentile": 16573.91, "90th_percentile": 16573.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 12968.63, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 12968.63, "10th_percentile": 12968.63, "90th_percentile": 12968.63, "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", "standard_charge_dollar": 11153.02, "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": 11153.02, "10th_percentile": 11153.02, "90th_percentile": 11153.02, "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": 6069.32, "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": 6069.32, "10th_percentile": 6069.32, "90th_percentile": 6069.32, "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": 6069.32, "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": 6069.32, "10th_percentile": 6069.32, "90th_percentile": 6069.32, "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 SELECT", "standard_charge_dollar": 6069.32, "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": 6069.32, "10th_percentile": 6069.32, "90th_percentile": 6069.32, "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." } ] } ] }, { "description": "BASEPLATE COMPONENT AUGMENT REV 110032420", "code_information": [ { "code": "SUP-344619", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 3774.18, "maximum": 22736.0, "setting": "outpatient", "gross_charge": 22736.0, "discounted_cash": 15915.2, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 3774.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $22,736.00 @ 12.8% = $2,910.21 due to $0.00 Claim Price", "median_amount": 2910.21, "10th_percentile": 2910.21, "90th_percentile": 2910.21, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22,736.00 @ 12.8% = $2,910.21 due to $0.00 Claim Price" }, { "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": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "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": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "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": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "count": "0", "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": 18188.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18188.8, "10th_percentile": 18188.8, "90th_percentile": 18188.8, "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": 18188.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18188.8, "10th_percentile": 18188.8, "90th_percentile": 18188.8, "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 HMO", "standard_charge_dollar": 4817.76, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4817.76, "10th_percentile": 4817.76, "90th_percentile": 4817.76, "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 HMO", "standard_charge_dollar": 4817.76, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4817.76, "10th_percentile": 4817.76, "90th_percentile": 4817.76, "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": 6206.93, "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": 6206.93, "10th_percentile": 6206.93, "90th_percentile": 6206.93, "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": 6206.93, "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": 6206.93, "10th_percentile": 6206.93, "90th_percentile": 6206.93, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 22736.0, "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 $22,736.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "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 $22,736.00 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 22736.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 22736.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 22736.0, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 22736.0, "10th_percentile": 22736.0, "90th_percentile": 22736.0, "count": "0", "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": 11981.87, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 14528.3, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 14528.3, "10th_percentile": 14528.3, "90th_percentile": 14528.3, "count": "0", "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": 4774.56, "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": 4774.56, "10th_percentile": 4774.56, "90th_percentile": 4774.56, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 14603.33, "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": 14603.33, "10th_percentile": 14603.33, "90th_percentile": 14603.33, "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": 10776.86, "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": 10776.86, "10th_percentile": 10776.86, "90th_percentile": 10776.86, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 10344.88, "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": 10344.88, "10th_percentile": 10344.88, "90th_percentile": 10344.88, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 17506.72, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 17506.72, "10th_percentile": 17506.72, "90th_percentile": 17506.72, "count": "0", "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": 20462.4, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 20462.4, "10th_percentile": 20462.4, "90th_percentile": 20462.4, "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": 11368.0, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 11368.0, "10th_percentile": 11368.0, "90th_percentile": 11368.0, "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 BROAD", "standard_charge_dollar": 11049.7, "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": 11049.7, "10th_percentile": 11049.7, "90th_percentile": 11049.7, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 9776.48, "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": 9776.48, "10th_percentile": 9776.48, "90th_percentile": 9776.48, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 5320.22, "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": 5320.22, "10th_percentile": 5320.22, "90th_percentile": 5320.22, "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 SELECT", "standard_charge_dollar": 5320.22, "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": 5320.22, "10th_percentile": 5320.22, "90th_percentile": 5320.22, "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": 5320.22, "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": 5320.22, "10th_percentile": 5320.22, "90th_percentile": 5320.22, "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." } ] } ] }, { "description": "BASEPLATE GLEN HYBRD SM 4MM", "code_information": [ { "code": "SUP-134103", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1967.84, "maximum": 11854.48, "setting": "outpatient", "gross_charge": 11854.48, "discounted_cash": 8298.14, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1967.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $11,854.48 @ 12.8% = $1,517.37 due to $0.00 Claim Price", "median_amount": 1517.37, "10th_percentile": 1517.37, "90th_percentile": 1517.37, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,854.48 @ 12.8% = $1,517.37 due to $0.00 Claim Price" }, { "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": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "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": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "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": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "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 BCBS PPO", "standard_charge_dollar": 3236.27, "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": 3236.27, "10th_percentile": 3236.27, "90th_percentile": 3236.27, "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": 3236.27, "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": 3236.27, "10th_percentile": 3236.27, "90th_percentile": 3236.27, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 9483.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 9483.58, "10th_percentile": 9483.58, "90th_percentile": 9483.58, "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": 9483.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 9483.58, "10th_percentile": 9483.58, "90th_percentile": 9483.58, "count": "0", "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": 2511.96, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2511.96, "10th_percentile": 2511.96, "90th_percentile": 2511.96, "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": 2511.96, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2511.96, "10th_percentile": 2511.96, "90th_percentile": 2511.96, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 11854.48, "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 $11,854.48 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "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 $11,854.48 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11854.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 11854.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 11854.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 11854.48, "10th_percentile": 11854.48, "90th_percentile": 11854.48, "count": "0", "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": 6247.31, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 5619.02, "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": 5619.02, "10th_percentile": 5619.02, "90th_percentile": 5619.02, "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": 9127.95, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 9127.95, "10th_percentile": 9127.95, "90th_percentile": 9127.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2489.44, "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": 2489.44, "10th_percentile": 2489.44, "90th_percentile": 2489.44, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 10669.03, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 10669.03, "10th_percentile": 10669.03, "90th_percentile": 10669.03, "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": 5393.79, "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": 5393.79, "10th_percentile": 5393.79, "90th_percentile": 5393.79, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 7614.13, "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": 7614.13, "10th_percentile": 7614.13, "90th_percentile": 7614.13, "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 BROAD", "standard_charge_dollar": 5761.28, "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": 5761.28, "10th_percentile": 5761.28, "90th_percentile": 5761.28, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 7575.01, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 7575.01, "10th_percentile": 7575.01, "90th_percentile": 7575.01, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 5927.24, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5927.24, "10th_percentile": 5927.24, "90th_percentile": 5927.24, "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", "standard_charge_dollar": 5097.43, "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": 5097.43, "10th_percentile": 5097.43, "90th_percentile": 5097.43, "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": 2773.95, "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": 2773.95, "10th_percentile": 2773.95, "90th_percentile": 2773.95, "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": 2773.95, "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": 2773.95, "10th_percentile": 2773.95, "90th_percentile": 2773.95, "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 SELECT", "standard_charge_dollar": 2773.95, "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": 2773.95, "10th_percentile": 2773.95, "90th_percentile": 2773.95, "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." } ] } ] }, { "description": "BASEPLATE GLENOID 30MM CMNTD HYDRO COATED POLY AEQUALIS", "code_information": [ { "code": "SUP-374531", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1572.03, "maximum": 9470.09, "setting": "outpatient", "gross_charge": 9470.09, "discounted_cash": 6629.06, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1572.03, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $9,470.09 @ 12.8% = $1,212.17 due to $0.00 Claim Price", "median_amount": 1212.17, "10th_percentile": 1212.17, "90th_percentile": 1212.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $9,470.09 @ 12.8% = $1,212.17 due to $0.00 Claim Price" }, { "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": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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 PPO", "standard_charge_dollar": 2585.33, "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": 2585.33, "10th_percentile": 2585.33, "90th_percentile": 2585.33, "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": 2585.33, "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": 2585.33, "10th_percentile": 2585.33, "90th_percentile": 2585.33, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 7576.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7576.07, "10th_percentile": 7576.07, "90th_percentile": 7576.07, "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": 7576.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7576.07, "10th_percentile": 7576.07, "90th_percentile": 7576.07, "count": "0", "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": 2006.71, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2006.71, "10th_percentile": 2006.71, "90th_percentile": 2006.71, "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": 2006.71, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2006.71, "10th_percentile": 2006.71, "90th_percentile": 2006.71, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 9470.09, "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 $9,470.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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 $9,470.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "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": 4990.74, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 4488.82, "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": 4488.82, "10th_percentile": 4488.82, "90th_percentile": 4488.82, "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": 7291.97, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 7291.97, "10th_percentile": 7291.97, "90th_percentile": 7291.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1988.72, "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": 1988.72, "10th_percentile": 1988.72, "90th_percentile": 1988.72, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 8523.08, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 8523.08, "10th_percentile": 8523.08, "90th_percentile": 8523.08, "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": 4308.89, "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": 4308.89, "10th_percentile": 4308.89, "90th_percentile": 4308.89, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 6082.64, "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": 6082.64, "10th_percentile": 6082.64, "90th_percentile": 6082.64, "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 BROAD", "standard_charge_dollar": 4602.46, "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": 4602.46, "10th_percentile": 4602.46, "90th_percentile": 4602.46, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6051.39, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6051.39, "10th_percentile": 6051.39, "90th_percentile": 6051.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 4735.05, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4735.05, "10th_percentile": 4735.05, "90th_percentile": 4735.05, "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", "standard_charge_dollar": 4072.14, "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": 4072.14, "10th_percentile": 4072.14, "90th_percentile": 4072.14, "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": 2216.0, "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": 2216.0, "10th_percentile": 2216.0, "90th_percentile": 2216.0, "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": 2216.0, "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": 2216.0, "10th_percentile": 2216.0, "90th_percentile": 2216.0, "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 SELECT", "standard_charge_dollar": 2216.0, "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": 2216.0, "10th_percentile": 2216.0, "90th_percentile": 2216.0, "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." } ] } ] }, { "description": "BASEPLATE GLENOID 40MM", "code_information": [ { "code": "SUP-418112", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1572.03, "maximum": 9470.09, "setting": "outpatient", "gross_charge": 9470.09, "discounted_cash": 6629.06, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1572.03, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $9,470.09 @ 12.8% = $1,212.17 due to $0.00 Claim Price", "median_amount": 1212.17, "10th_percentile": 1212.17, "90th_percentile": 1212.17, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $9,470.09 @ 12.8% = $1,212.17 due to $0.00 Claim Price" }, { "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": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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 PPO", "standard_charge_dollar": 2585.33, "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": 2585.33, "10th_percentile": 2585.33, "90th_percentile": 2585.33, "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": 2585.33, "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": 2585.33, "10th_percentile": 2585.33, "90th_percentile": 2585.33, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 7576.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7576.07, "10th_percentile": 7576.07, "90th_percentile": 7576.07, "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": 7576.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 7576.07, "10th_percentile": 7576.07, "90th_percentile": 7576.07, "count": "0", "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": 2006.71, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2006.71, "10th_percentile": 2006.71, "90th_percentile": 2006.71, "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": 2006.71, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2006.71, "10th_percentile": 2006.71, "90th_percentile": 2006.71, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 9470.09, "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 $9,470.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "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 $9,470.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "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": 4990.74, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 4488.82, "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": 4488.82, "10th_percentile": 4488.82, "90th_percentile": 4488.82, "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": 7291.97, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 7291.97, "10th_percentile": 7291.97, "90th_percentile": 7291.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1988.72, "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": 1988.72, "10th_percentile": 1988.72, "90th_percentile": 1988.72, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 8523.08, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 8523.08, "10th_percentile": 8523.08, "90th_percentile": 8523.08, "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": 4308.89, "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": 4308.89, "10th_percentile": 4308.89, "90th_percentile": 4308.89, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 6082.64, "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": 6082.64, "10th_percentile": 6082.64, "90th_percentile": 6082.64, "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 BROAD", "standard_charge_dollar": 4602.46, "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": 4602.46, "10th_percentile": 4602.46, "90th_percentile": 4602.46, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6051.39, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6051.39, "10th_percentile": 6051.39, "90th_percentile": 6051.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 4735.05, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 4735.05, "10th_percentile": 4735.05, "90th_percentile": 4735.05, "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", "standard_charge_dollar": 4072.14, "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": 4072.14, "10th_percentile": 4072.14, "90th_percentile": 4072.14, "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": 2216.0, "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": 2216.0, "10th_percentile": 2216.0, "90th_percentile": 2216.0, "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": 2216.0, "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": 2216.0, "10th_percentile": 2216.0, "90th_percentile": 2216.0, "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 SELECT", "standard_charge_dollar": 2216.0, "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": 2216.0, "10th_percentile": 2216.0, "90th_percentile": 2216.0, "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." } ] } ] }, { "description": "BASEPLATE GLENOSPHERE 24.5X20 +6MM REVRS SHLDR", "code_information": [ { "code": "SUP-425057", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2386.44, "maximum": 14376.12, "setting": "outpatient", "gross_charge": 14376.12, "discounted_cash": 10063.28, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2386.44, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $14,376.12 @ 12.8% = $1,840.14 due to $0.00 Claim Price", "median_amount": 1840.14, "10th_percentile": 1840.14, "90th_percentile": 1840.14, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,376.12 @ 12.8% = $1,840.14 due to $0.00 Claim Price" }, { "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": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "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": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "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": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "count": "0", "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": 11500.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11500.9, "10th_percentile": 11500.9, "90th_percentile": 11500.9, "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": 11500.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11500.9, "10th_percentile": 11500.9, "90th_percentile": 11500.9, "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": 3046.3, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3046.3, "10th_percentile": 3046.3, "90th_percentile": 3046.3, "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 HMO", "standard_charge_dollar": 3046.3, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3046.3, "10th_percentile": 3046.3, "90th_percentile": 3046.3, "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": 3924.68, "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": 3924.68, "10th_percentile": 3924.68, "90th_percentile": 3924.68, "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": 3924.68, "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": 3924.68, "10th_percentile": 3924.68, "90th_percentile": 3924.68, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 14376.12, "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 $14,376.12 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "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 $14,376.12 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14376.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14376.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 14376.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 14376.12, "10th_percentile": 14376.12, "90th_percentile": 14376.12, "count": "0", "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": 7576.22, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 9186.34, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 9186.34, "10th_percentile": 9186.34, "90th_percentile": 9186.34, "count": "0", "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": 3018.99, "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": 3018.99, "10th_percentile": 3018.99, "90th_percentile": 3018.99, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 9233.78, "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": 9233.78, "10th_percentile": 9233.78, "90th_percentile": 9233.78, "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 CORE", "standard_charge_dollar": 6814.28, "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": 6814.28, "10th_percentile": 6814.28, "90th_percentile": 6814.28, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 6541.13, "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": 6541.13, "10th_percentile": 6541.13, "90th_percentile": 6541.13, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 11069.61, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 11069.61, "10th_percentile": 11069.61, "90th_percentile": 11069.61, "count": "0", "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": 12938.51, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 12938.51, "10th_percentile": 12938.51, "90th_percentile": 12938.51, "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": 7188.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 7188.06, "10th_percentile": 7188.06, "90th_percentile": 7188.06, "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 BROAD", "standard_charge_dollar": 6986.79, "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": 6986.79, "10th_percentile": 6986.79, "90th_percentile": 6986.79, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 6181.73, "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": 6181.73, "10th_percentile": 6181.73, "90th_percentile": 6181.73, "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 OPTIONS", "standard_charge_dollar": 3364.01, "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": 3364.01, "10th_percentile": 3364.01, "90th_percentile": 3364.01, "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 SELECT", "standard_charge_dollar": 3364.01, "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": 3364.01, "10th_percentile": 3364.01, "90th_percentile": 3364.01, "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": 3364.01, "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": 3364.01, "10th_percentile": 3364.01, "90th_percentile": 3364.01, "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." } ] } ] }, { "description": "BASEPLATE MONOBLCK 24MM POST SHLDR MOD UNIVERS REVERS", "code_information": [ { "code": "SUP-423870", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2838.4, "maximum": 17098.77, "setting": "outpatient", "gross_charge": 17098.77, "discounted_cash": 11969.14, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2838.4, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $17,098.77 @ 12.8% = $2,188.64 due to $0.00 Claim Price", "median_amount": 2188.64, "10th_percentile": 2188.64, "90th_percentile": 2188.64, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $17,098.77 @ 12.8% = $2,188.64 due to $0.00 Claim Price" }, { "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": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "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": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "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": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "count": "0", "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": 13679.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 13679.02, "10th_percentile": 13679.02, "90th_percentile": 13679.02, "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": 13679.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 13679.02, "10th_percentile": 13679.02, "90th_percentile": 13679.02, "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": 3623.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3623.23, "10th_percentile": 3623.23, "90th_percentile": 3623.23, "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 HMO", "standard_charge_dollar": 3623.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3623.23, "10th_percentile": 3623.23, "90th_percentile": 3623.23, "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": 4667.96, "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": 4667.96, "10th_percentile": 4667.96, "90th_percentile": 4667.96, "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": 4667.96, "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": 4667.96, "10th_percentile": 4667.96, "90th_percentile": 4667.96, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 17098.77, "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 $17,098.77 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "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 $17,098.77 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17098.77, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 17098.77, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 10926.11, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 10926.11, "10th_percentile": 10926.11, "90th_percentile": 10926.11, "count": "0", "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": 3590.74, "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": 3590.74, "10th_percentile": 3590.74, "90th_percentile": 3590.74, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 10982.54, "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": 10982.54, "10th_percentile": 10982.54, "90th_percentile": 10982.54, "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": 8104.82, "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": 8104.82, "10th_percentile": 8104.82, "90th_percentile": 8104.82, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 7779.94, "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": 7779.94, "10th_percentile": 7779.94, "90th_percentile": 7779.94, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 13166.05, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 13166.05, "10th_percentile": 13166.05, "90th_percentile": 13166.05, "count": "0", "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": 15388.89, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 15388.89, "10th_percentile": 15388.89, "90th_percentile": 15388.89, "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": 8549.39, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 8549.39, "10th_percentile": 8549.39, "90th_percentile": 8549.39, "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 BROAD", "standard_charge_dollar": 8310.0, "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": 8310.0, "10th_percentile": 8310.0, "90th_percentile": 8310.0, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 7352.47, "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": 7352.47, "10th_percentile": 7352.47, "90th_percentile": 7352.47, "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 OPTIONS", "standard_charge_dollar": 4001.11, "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": 4001.11, "10th_percentile": 4001.11, "90th_percentile": 4001.11, "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 SELECT", "standard_charge_dollar": 4001.11, "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": 4001.11, "10th_percentile": 4001.11, "90th_percentile": 4001.11, "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": 4001.11, "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": 4001.11, "10th_percentile": 4001.11, "90th_percentile": 4001.11, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 17098.77, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 17098.77, "10th_percentile": 17098.77, "90th_percentile": 17098.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 9011.05, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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." } ] } ] }, { "description": "BASEPLATE TBL SZ2 RGHT KN FML TPRD HNGD CMNTD LGN", "code_information": [ { "code": "SUP-445181", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 7981.29, "maximum": 48080.08, "setting": "outpatient", "gross_charge": 48080.08, "discounted_cash": 33656.06, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 38464.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 38464.06, "10th_percentile": 38464.06, "90th_percentile": 38464.06, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 48080.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 25338.2, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 30881.84, "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": 30881.84, "10th_percentile": 30881.84, "90th_percentile": 30881.84, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 22789.96, "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": 22789.96, "10th_percentile": 22789.96, "90th_percentile": 22789.96, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 7981.29, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $48,080.08 @ 12.8% = $6,154.25 due to $0.00 Claim Price", "median_amount": 6154.25, "10th_percentile": 6154.25, "90th_percentile": 6154.25, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $48,080.08 @ 12.8% = $6,154.25 due to $0.00 Claim Price" }, { "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": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "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": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "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": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "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 PPO", "standard_charge_dollar": 13125.86, "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": 13125.86, "10th_percentile": 13125.86, "90th_percentile": 13125.86, "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": 13125.86, "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": 13125.86, "10th_percentile": 13125.86, "90th_percentile": 13125.86, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 38464.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 38464.06, "10th_percentile": 38464.06, "90th_percentile": 38464.06, "count": "0", "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": 10188.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 10188.17, "10th_percentile": 10188.17, "90th_percentile": 10188.17, "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": 10188.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 10188.17, "10th_percentile": 10188.17, "90th_percentile": 10188.17, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 48080.08, "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 $48,080.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "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 $48,080.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 48080.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 48080.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 48080.08, "10th_percentile": 48080.08, "90th_percentile": 48080.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 37021.66, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 37021.66, "10th_percentile": 37021.66, "90th_percentile": 37021.66, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 10096.82, "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": 10096.82, "10th_percentile": 10096.82, "90th_percentile": 10096.82, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 43272.07, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 43272.07, "10th_percentile": 43272.07, "90th_percentile": 43272.07, "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": 21876.44, "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": 21876.44, "10th_percentile": 21876.44, "90th_percentile": 21876.44, "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 BROAD", "standard_charge_dollar": 23366.92, "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": 23366.92, "10th_percentile": 23366.92, "90th_percentile": 23366.92, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 30723.17, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 30723.17, "10th_percentile": 30723.17, "90th_percentile": 30723.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 24040.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 24040.04, "10th_percentile": 24040.04, "90th_percentile": 24040.04, "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", "standard_charge_dollar": 20674.43, "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": 20674.43, "10th_percentile": 20674.43, "90th_percentile": 20674.43, "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": 11250.74, "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": 11250.74, "10th_percentile": 11250.74, "90th_percentile": 11250.74, "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": 11250.74, "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": 11250.74, "10th_percentile": 11250.74, "90th_percentile": 11250.74, "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 SELECT", "standard_charge_dollar": 11250.74, "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": 11250.74, "10th_percentile": 11250.74, "90th_percentile": 11250.74, "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." } ] } ] }, { "description": "BASEPLATE TIB CEM PRI FIX TRITHLON SZ 1", "code_information": [ { "code": "SUP-115137", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1128.08, "maximum": 6795.67, "setting": "outpatient", "gross_charge": 6795.67, "discounted_cash": 4756.97, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1128.08, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $6,795.67 @ 12.8% = $869.85 due to $0.00 Claim Price", "median_amount": 869.85, "10th_percentile": 869.85, "90th_percentile": 869.85, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,795.67 @ 12.8% = $869.85 due to $0.00 Claim Price" }, { "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": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "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": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "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": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "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": 5436.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5436.54, "10th_percentile": 5436.54, "90th_percentile": 5436.54, "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": 5436.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5436.54, "10th_percentile": 5436.54, "90th_percentile": 5436.54, "count": "0", "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": 1440.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1440.0, "10th_percentile": 1440.0, "90th_percentile": 1440.0, "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": 1440.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1440.0, "10th_percentile": 1440.0, "90th_percentile": 1440.0, "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": 1855.22, "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": 1855.22, "10th_percentile": 1855.22, "90th_percentile": 1855.22, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1855.22, "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": 1855.22, "10th_percentile": 1855.22, "90th_percentile": 1855.22, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6795.67, "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 $6,795.67 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "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 $6,795.67 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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 6795.67, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6795.67, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6795.67, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6795.67, "10th_percentile": 6795.67, "90th_percentile": 6795.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3581.32, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1427.09, "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": 1427.09, "10th_percentile": 1427.09, "90th_percentile": 1427.09, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6116.1, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6116.1, "10th_percentile": 6116.1, "90th_percentile": 6116.1, "count": "0", "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": 3302.7, "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": 3302.7, "10th_percentile": 3302.7, "90th_percentile": 3302.7, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3092.03, "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": 3092.03, "10th_percentile": 3092.03, "90th_percentile": 3092.03, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4342.43, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4342.43, "10th_percentile": 4342.43, "90th_percentile": 4342.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3397.84, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3397.84, "10th_percentile": 3397.84, "90th_percentile": 3397.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5232.67, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5232.67, "10th_percentile": 5232.67, "90th_percentile": 5232.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2922.14, "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": 2922.14, "10th_percentile": 2922.14, "90th_percentile": 2922.14, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4364.86, "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": 4364.86, "10th_percentile": 4364.86, "90th_percentile": 4364.86, "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": 3221.15, "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": 3221.15, "10th_percentile": 3221.15, "90th_percentile": 3221.15, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1590.19, "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": 1590.19, "10th_percentile": 1590.19, "90th_percentile": 1590.19, "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": 1590.19, "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": 1590.19, "10th_percentile": 1590.19, "90th_percentile": 1590.19, "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 SELECT", "standard_charge_dollar": 1590.19, "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": 1590.19, "10th_percentile": 1590.19, "90th_percentile": 1590.19, "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." } ] } ] }, { "description": "BASEPLATE TIB FIN EMPOWR SZ 8 R NON POR", "code_information": [ { "code": "SUP-336703", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2235.43, "maximum": 13466.47, "setting": "outpatient", "gross_charge": 13466.47, "discounted_cash": 9426.53, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2235.43, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $13,466.47 @ 12.8% = $1,723.71 due to $0.00 Claim Price", "median_amount": 1723.71, "10th_percentile": 1723.71, "90th_percentile": 1723.71, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $13,466.47 @ 12.8% = $1,723.71 due to $0.00 Claim Price" }, { "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": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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": 10773.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10773.18, "10th_percentile": 10773.18, "90th_percentile": 10773.18, "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": 10773.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10773.18, "10th_percentile": 10773.18, "90th_percentile": 10773.18, "count": "0", "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": 2853.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2853.54, "10th_percentile": 2853.54, "90th_percentile": 2853.54, "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": 2853.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2853.54, "10th_percentile": 2853.54, "90th_percentile": 2853.54, "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": 3676.35, "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": 3676.35, "10th_percentile": 3676.35, "90th_percentile": 3676.35, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 3676.35, "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": 3676.35, "10th_percentile": 3676.35, "90th_percentile": 3676.35, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 13466.47, "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 $13,466.47 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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 $13,466.47 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": 13466.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 13466.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 13466.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 7096.83, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2827.96, "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": 2827.96, "10th_percentile": 2827.96, "90th_percentile": 2827.96, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 12119.82, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 12119.82, "10th_percentile": 12119.82, "90th_percentile": 12119.82, "count": "0", "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": 6544.7, "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": 6544.7, "10th_percentile": 6544.7, "90th_percentile": 6544.7, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 6127.24, "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": 6127.24, "10th_percentile": 6127.24, "90th_percentile": 6127.24, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 8605.07, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 8605.07, "10th_percentile": 8605.07, "90th_percentile": 8605.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 6733.24, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6733.24, "10th_percentile": 6733.24, "90th_percentile": 6733.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 10369.18, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 10369.18, "10th_percentile": 10369.18, "90th_percentile": 10369.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 5790.58, "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": 5790.58, "10th_percentile": 5790.58, "90th_percentile": 5790.58, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 8649.51, "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": 8649.51, "10th_percentile": 8649.51, "90th_percentile": 8649.51, "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": 6383.11, "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": 6383.11, "10th_percentile": 6383.11, "90th_percentile": 6383.11, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3151.15, "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": 3151.15, "10th_percentile": 3151.15, "90th_percentile": 3151.15, "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": 3151.15, "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": 3151.15, "10th_percentile": 3151.15, "90th_percentile": 3151.15, "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 SELECT", "standard_charge_dollar": 3151.15, "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": 3151.15, "10th_percentile": 3151.15, "90th_percentile": 3151.15, "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." } ] } ] }, { "description": "BASEPLATE TIB FIX CEM REV SZ 5 L", "code_information": [ { "code": "SUP-155156", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 3145.52, "maximum": 18948.91, "setting": "outpatient", "gross_charge": 18948.91, "discounted_cash": 13264.24, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 3145.52, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $18,948.91 @ 12.8% = $2,425.46 due to $0.00 Claim Price", "median_amount": 2425.46, "10th_percentile": 2425.46, "90th_percentile": 2425.46, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $18,948.91 @ 12.8% = $2,425.46 due to $0.00 Claim Price" }, { "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": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "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": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "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": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "count": "0", "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": 15159.13, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 15159.13, "10th_percentile": 15159.13, "90th_percentile": 15159.13, "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": 15159.13, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 15159.13, "10th_percentile": 15159.13, "90th_percentile": 15159.13, "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": 4015.27, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4015.27, "10th_percentile": 4015.27, "90th_percentile": 4015.27, "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 HMO", "standard_charge_dollar": 4015.27, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4015.27, "10th_percentile": 4015.27, "90th_percentile": 4015.27, "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": 5173.05, "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": 5173.05, "10th_percentile": 5173.05, "90th_percentile": 5173.05, "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": 5173.05, "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": 5173.05, "10th_percentile": 5173.05, "90th_percentile": 5173.05, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 18948.91, "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 $18,948.91 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "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 $18,948.91 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18948.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 18948.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 18948.91, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 18948.91, "10th_percentile": 18948.91, "90th_percentile": 18948.91, "count": "0", "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": 9986.08, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 12108.35, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 12108.35, "10th_percentile": 12108.35, "90th_percentile": 12108.35, "count": "0", "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": 3979.27, "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": 3979.27, "10th_percentile": 3979.27, "90th_percentile": 3979.27, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 12170.88, "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": 12170.88, "10th_percentile": 12170.88, "90th_percentile": 12170.88, "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": 8981.78, "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": 8981.78, "10th_percentile": 8981.78, "90th_percentile": 8981.78, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 8621.75, "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": 8621.75, "10th_percentile": 8621.75, "90th_percentile": 8621.75, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 14590.66, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 14590.66, "10th_percentile": 14590.66, "90th_percentile": 14590.66, "count": "0", "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": 17054.02, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 17054.02, "10th_percentile": 17054.02, "90th_percentile": 17054.02, "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": 9474.46, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 9474.46, "10th_percentile": 9474.46, "90th_percentile": 9474.46, "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 BROAD", "standard_charge_dollar": 9209.17, "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": 9209.17, "10th_percentile": 9209.17, "90th_percentile": 9209.17, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 8148.03, "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": 8148.03, "10th_percentile": 8148.03, "90th_percentile": 8148.03, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 4434.04, "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": 4434.04, "10th_percentile": 4434.04, "90th_percentile": 4434.04, "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 SELECT", "standard_charge_dollar": 4434.04, "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": 4434.04, "10th_percentile": 4434.04, "90th_percentile": 4434.04, "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": 4434.04, "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": 4434.04, "10th_percentile": 4434.04, "90th_percentile": 4434.04, "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." } ] } ] }, { "description": "BASEPLATE TIB FIX HNG GMK SZ 1 L", "code_information": [ { "code": "SUP-155180", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 4215.05, "maximum": 25391.85, "setting": "outpatient", "gross_charge": 25391.85, "discounted_cash": 17774.29, "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: $25,391.85 @ 12.8% = $3,250.16 due to $0.00 Claim Price", "median_amount": 3250.16, "10th_percentile": 3250.16, "90th_percentile": 3250.16, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $25,391.85 @ 12.8% = $3,250.16 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "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": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "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": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "count": "0", "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": 20313.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 20313.48, "10th_percentile": 20313.48, "90th_percentile": 20313.48, "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": 20313.48, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 20313.48, "10th_percentile": 20313.48, "90th_percentile": 20313.48, "count": "0", "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": 5380.53, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5380.53, "10th_percentile": 5380.53, "90th_percentile": 5380.53, "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": 6931.98, "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": 6931.98, "10th_percentile": 6931.98, "90th_percentile": 6931.98, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 25391.85, "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 $25,391.85 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "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 $25,391.85 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 25391.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 25391.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 25391.85, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "count": "0", "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": 13381.5, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 16225.39, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 16225.39, "10th_percentile": 16225.39, "90th_percentile": 16225.39, "count": "0", "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": 5332.29, "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": 5332.29, "10th_percentile": 5332.29, "90th_percentile": 5332.29, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 16309.19, "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": 16309.19, "10th_percentile": 16309.19, "90th_percentile": 16309.19, "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": 12035.74, "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": 12035.74, "10th_percentile": 12035.74, "90th_percentile": 12035.74, "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": 19551.72, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 19551.72, "10th_percentile": 19551.72, "90th_percentile": 19551.72, "count": "0", "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": 22852.67, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 22852.67, "10th_percentile": 22852.67, "90th_percentile": 22852.67, "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": 12695.93, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 12695.93, "10th_percentile": 12695.93, "90th_percentile": 12695.93, "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 BROAD", "standard_charge_dollar": 12340.44, "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": 12340.44, "10th_percentile": 12340.44, "90th_percentile": 12340.44, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 5941.69, "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": 5941.69, "10th_percentile": 5941.69, "90th_percentile": 5941.69, "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 SELECT", "standard_charge_dollar": 5941.69, "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": 5941.69, "10th_percentile": 5941.69, "90th_percentile": 5941.69, "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": 5941.69, "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": 5941.69, "10th_percentile": 5941.69, "90th_percentile": 5941.69, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 4215.05, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 25391.85, "10th_percentile": 25391.85, "90th_percentile": 25391.85, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 6931.98, "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": 6931.98, "10th_percentile": 6931.98, "90th_percentile": 6931.98, "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 HMO", "standard_charge_dollar": 5380.53, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 5380.53, "10th_percentile": 5380.53, "90th_percentile": 5380.53, "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 ASA", "standard_charge_dollar": 11553.29, "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": 11553.29, "10th_percentile": 11553.29, "90th_percentile": 11553.29, "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": 10918.5, "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": 10918.5, "10th_percentile": 10918.5, "90th_percentile": 10918.5, "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." } ] } ] }, { "description": "BASEPLATE TIB FIX REV GMK SZ 2 R", "code_information": [ { "code": "SUP-151004", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2827.7, "maximum": 17034.31, "setting": "outpatient", "gross_charge": 17034.31, "discounted_cash": 11924.02, "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: $17,034.31 @ 12.8% = $2,180.39 due to $0.00 Claim Price", "median_amount": 2180.39, "10th_percentile": 2180.39, "90th_percentile": 2180.39, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $17,034.31 @ 12.8% = $2,180.39 due to $0.00 Claim Price" }, { "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": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "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": 13627.45, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 13627.45, "10th_percentile": 13627.45, "90th_percentile": 13627.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17034.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 17034.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 8977.08, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 8074.26, "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": 8074.26, "10th_percentile": 8074.26, "90th_percentile": 8074.26, "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": 15330.88, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 15330.88, "10th_percentile": 15330.88, "90th_percentile": 15330.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 10941.14, "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": 10941.14, "10th_percentile": 10941.14, "90th_percentile": 10941.14, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 10884.92, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 10884.92, "10th_percentile": 10884.92, "90th_percentile": 10884.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 8517.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 8517.16, "10th_percentile": 8517.16, "90th_percentile": 8517.16, "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": 2827.7, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "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": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "count": "0", "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": 13627.45, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 13627.45, "10th_percentile": 13627.45, "90th_percentile": 13627.45, "count": "0", "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": 3609.57, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3609.57, "10th_percentile": 3609.57, "90th_percentile": 3609.57, "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": 3609.57, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3609.57, "10th_percentile": 3609.57, "90th_percentile": 3609.57, "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": 4650.37, "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": 4650.37, "10th_percentile": 4650.37, "90th_percentile": 4650.37, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 4650.37, "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": 4650.37, "10th_percentile": 4650.37, "90th_percentile": 4650.37, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 17034.31, "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 $17,034.31 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "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 $17,034.31 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": 17034.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 17034.31, "10th_percentile": 17034.31, "90th_percentile": 17034.31, "count": "0", "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": 3577.21, "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": 3577.21, "10th_percentile": 3577.21, "90th_percentile": 3577.21, "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": 8278.67, "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": 8278.67, "10th_percentile": 8278.67, "90th_percentile": 8278.67, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 7750.61, "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": 7750.61, "10th_percentile": 7750.61, "90th_percentile": 7750.61, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 13116.42, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 13116.42, "10th_percentile": 13116.42, "90th_percentile": 13116.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 7324.75, "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": 7324.75, "10th_percentile": 7324.75, "90th_percentile": 7324.75, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3986.03, "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": 3986.03, "10th_percentile": 3986.03, "90th_percentile": 3986.03, "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": 3986.03, "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": 3986.03, "10th_percentile": 3986.03, "90th_percentile": 3986.03, "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 SELECT", "standard_charge_dollar": 3986.03, "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": 3986.03, "10th_percentile": 3986.03, "90th_percentile": 3986.03, "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." } ] } ] }, { "description": "BASEPLATE TIB MOB BEAR CEM SZ 5", "code_information": [ { "code": "SUP-20748", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1273.64, "maximum": 7672.53, "setting": "outpatient", "gross_charge": 7672.53, "discounted_cash": 5370.77, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1273.64, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,672.53 @ 12.8% = $982.08 due to $0.00 Claim Price", "median_amount": 982.08, "10th_percentile": 982.08, "90th_percentile": 982.08, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,672.53 @ 12.8% = $982.08 due to $0.00 Claim Price" }, { "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": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "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": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "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": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "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": 6138.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6138.02, "10th_percentile": 6138.02, "90th_percentile": 6138.02, "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": 6138.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6138.02, "10th_percentile": 6138.02, "90th_percentile": 6138.02, "count": "0", "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": 1625.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1625.81, "10th_percentile": 1625.81, "90th_percentile": 1625.81, "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": 1625.81, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1625.81, "10th_percentile": 1625.81, "90th_percentile": 1625.81, "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": 2094.6, "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": 2094.6, "10th_percentile": 2094.6, "90th_percentile": 2094.6, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2094.6, "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": 2094.6, "10th_percentile": 2094.6, "90th_percentile": 2094.6, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7672.53, "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 $7,672.53 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "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 $7,672.53 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": 7672.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7672.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7672.53, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7672.53, "10th_percentile": 7672.53, "90th_percentile": 7672.53, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4043.42, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1611.23, "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": 1611.23, "10th_percentile": 1611.23, "90th_percentile": 1611.23, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6905.28, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6905.28, "10th_percentile": 6905.28, "90th_percentile": 6905.28, "count": "0", "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": 3728.85, "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": 3728.85, "10th_percentile": 3728.85, "90th_percentile": 3728.85, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3491.0, "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": 3491.0, "10th_percentile": 3491.0, "90th_percentile": 3491.0, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4902.75, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4902.75, "10th_percentile": 4902.75, "90th_percentile": 4902.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3836.27, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3836.27, "10th_percentile": 3836.27, "90th_percentile": 3836.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5907.85, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5907.85, "10th_percentile": 5907.85, "90th_percentile": 5907.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3299.19, "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": 3299.19, "10th_percentile": 3299.19, "90th_percentile": 3299.19, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4928.07, "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": 4928.07, "10th_percentile": 4928.07, "90th_percentile": 4928.07, "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": 3636.78, "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": 3636.78, "10th_percentile": 3636.78, "90th_percentile": 3636.78, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1795.37, "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": 1795.37, "10th_percentile": 1795.37, "90th_percentile": 1795.37, "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": 1795.37, "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": 1795.37, "10th_percentile": 1795.37, "90th_percentile": 1795.37, "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 SELECT", "standard_charge_dollar": 1795.37, "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": 1795.37, "10th_percentile": 1795.37, "90th_percentile": 1795.37, "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." } ] } ] }, { "description": "BASEPLATE TIB MOD OSS 71MM", "code_information": [ { "code": "SUP-115636", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 5394.41, "maximum": 32496.43, "setting": "outpatient", "gross_charge": 32496.43, "discounted_cash": 22747.5, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 5394.41, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $32,496.43 @ 12.8% = $4,159.54 due to $0.00 Claim Price", "median_amount": 4159.54, "10th_percentile": 4159.54, "90th_percentile": 4159.54, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $32,496.43 @ 12.8% = $4,159.54 due to $0.00 Claim Price" }, { "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": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "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": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "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": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "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 PPO", "standard_charge_dollar": 8871.53, "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": 8871.53, "10th_percentile": 8871.53, "90th_percentile": 8871.53, "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": 8871.53, "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": 8871.53, "10th_percentile": 8871.53, "90th_percentile": 8871.53, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 25997.14, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 25997.14, "10th_percentile": 25997.14, "90th_percentile": 25997.14, "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": 25997.14, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 25997.14, "10th_percentile": 25997.14, "90th_percentile": 25997.14, "count": "0", "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": 6885.99, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 6885.99, "10th_percentile": 6885.99, "90th_percentile": 6885.99, "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": 6885.99, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 6885.99, "10th_percentile": 6885.99, "90th_percentile": 6885.99, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 32496.43, "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 $32,496.43 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "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 $32,496.43 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 32496.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 32496.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 32496.43, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 32496.43, "10th_percentile": 32496.43, "90th_percentile": 32496.43, "count": "0", "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": 17125.62, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 15403.31, "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": 15403.31, "10th_percentile": 15403.31, "90th_percentile": 15403.31, "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": 25022.25, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 25022.25, "10th_percentile": 25022.25, "90th_percentile": 25022.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 6824.25, "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": 6824.25, "10th_percentile": 6824.25, "90th_percentile": 6824.25, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 29246.79, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 29246.79, "10th_percentile": 29246.79, "90th_percentile": 29246.79, "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": 14785.88, "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": 14785.88, "10th_percentile": 14785.88, "90th_percentile": 14785.88, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 20872.46, "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": 20872.46, "10th_percentile": 20872.46, "90th_percentile": 20872.46, "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 BROAD", "standard_charge_dollar": 15793.26, "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": 15793.26, "10th_percentile": 15793.26, "90th_percentile": 15793.26, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 20765.22, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 20765.22, "10th_percentile": 20765.22, "90th_percentile": 20765.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 16248.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 16248.22, "10th_percentile": 16248.22, "90th_percentile": 16248.22, "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", "standard_charge_dollar": 13973.46, "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": 13973.46, "10th_percentile": 13973.46, "90th_percentile": 13973.46, "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": 7604.16, "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": 7604.16, "10th_percentile": 7604.16, "90th_percentile": 7604.16, "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": 7604.16, "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": 7604.16, "10th_percentile": 7604.16, "90th_percentile": 7604.16, "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 SELECT", "standard_charge_dollar": 7604.16, "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": 7604.16, "10th_percentile": 7604.16, "90th_percentile": 7604.16, "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." } ] } ] }, { "description": "BASEPLATE TIB REV LEGN SZ 5 L", "code_information": [ { "code": "SUP-132062", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 3756.81, "maximum": 22631.41, "setting": "outpatient", "gross_charge": 22631.41, "discounted_cash": 15841.99, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 3756.81, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $22,631.41 @ 12.8% = $2,896.82 due to $0.00 Claim Price", "median_amount": 2896.82, "10th_percentile": 2896.82, "90th_percentile": 2896.82, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $22,631.41 @ 12.8% = $2,896.82 due to $0.00 Claim Price" }, { "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": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "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": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "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": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "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 PPO", "standard_charge_dollar": 6178.37, "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": 6178.37, "10th_percentile": 6178.37, "90th_percentile": 6178.37, "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": 6178.37, "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": 6178.37, "10th_percentile": 6178.37, "90th_percentile": 6178.37, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 18105.13, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18105.13, "10th_percentile": 18105.13, "90th_percentile": 18105.13, "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": 18105.13, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 18105.13, "10th_percentile": 18105.13, "90th_percentile": 18105.13, "count": "0", "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": 4795.6, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4795.6, "10th_percentile": 4795.6, "90th_percentile": 4795.6, "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": 4795.6, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 4795.6, "10th_percentile": 4795.6, "90th_percentile": 4795.6, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 22631.41, "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 $22,631.41 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "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 $22,631.41 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 22631.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 22631.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 22631.41, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 22631.41, "10th_percentile": 22631.41, "90th_percentile": 22631.41, "count": "0", "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": 11926.75, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 10727.29, "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": 10727.29, "10th_percentile": 10727.29, "90th_percentile": 10727.29, "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": 17426.19, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 17426.19, "10th_percentile": 17426.19, "90th_percentile": 17426.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 4752.6, "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": 4752.6, "10th_percentile": 4752.6, "90th_percentile": 4752.6, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 20368.27, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 20368.27, "10th_percentile": 20368.27, "90th_percentile": 20368.27, "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": 10297.29, "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": 10297.29, "10th_percentile": 10297.29, "90th_percentile": 10297.29, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 14536.15, "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": 14536.15, "10th_percentile": 14536.15, "90th_percentile": 14536.15, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 10998.87, "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": 10998.87, "10th_percentile": 10998.87, "90th_percentile": 10998.87, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 14461.47, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 14461.47, "10th_percentile": 14461.47, "90th_percentile": 14461.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 11315.71, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 11315.71, "10th_percentile": 11315.71, "90th_percentile": 11315.71, "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", "standard_charge_dollar": 9731.51, "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": 9731.51, "10th_percentile": 9731.51, "90th_percentile": 9731.51, "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": 5295.75, "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": 5295.75, "10th_percentile": 5295.75, "90th_percentile": 5295.75, "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": 5295.75, "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": 5295.75, "10th_percentile": 5295.75, "90th_percentile": 5295.75, "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 SELECT", "standard_charge_dollar": 5295.75, "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": 5295.75, "10th_percentile": 5295.75, "90th_percentile": 5295.75, "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." } ] } ] }, { "description": "BASEPLATE TIB REV MAXM INTLOK 67MM", "code_information": [ { "code": "SUP-135586", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2981.04, "maximum": 17958.09, "setting": "outpatient", "gross_charge": 17958.09, "discounted_cash": 12570.66, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2981.04, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $17,958.09 @ 12.8% = $2,298.64 due to $0.00 Claim Price", "median_amount": 2298.64, "10th_percentile": 2298.64, "90th_percentile": 2298.64, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $17,958.09 @ 12.8% = $2,298.64 due to $0.00 Claim Price" }, { "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": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "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": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "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": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "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 PPO", "standard_charge_dollar": 4902.56, "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": 4902.56, "10th_percentile": 4902.56, "90th_percentile": 4902.56, "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": 4902.56, "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": 4902.56, "10th_percentile": 4902.56, "90th_percentile": 4902.56, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 14366.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14366.47, "10th_percentile": 14366.47, "90th_percentile": 14366.47, "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": 14366.47, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14366.47, "10th_percentile": 14366.47, "90th_percentile": 14366.47, "count": "0", "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": 3805.32, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3805.32, "10th_percentile": 3805.32, "90th_percentile": 3805.32, "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": 3805.32, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3805.32, "10th_percentile": 3805.32, "90th_percentile": 3805.32, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 17958.09, "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 $17,958.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "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 $17,958.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 17958.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 17958.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 17958.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 17958.09, "10th_percentile": 17958.09, "90th_percentile": 17958.09, "count": "0", "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": 9463.91, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 8512.13, "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": 8512.13, "10th_percentile": 8512.13, "90th_percentile": 8512.13, "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": 13827.73, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 13827.73, "10th_percentile": 13827.73, "90th_percentile": 13827.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 3771.2, "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": 3771.2, "10th_percentile": 3771.2, "90th_percentile": 3771.2, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 16162.28, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 16162.28, "10th_percentile": 16162.28, "90th_percentile": 16162.28, "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": 8170.93, "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": 8170.93, "10th_percentile": 8170.93, "90th_percentile": 8170.93, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 11534.48, "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": 11534.48, "10th_percentile": 11534.48, "90th_percentile": 11534.48, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 8727.63, "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": 8727.63, "10th_percentile": 8727.63, "90th_percentile": 8727.63, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 11475.22, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 11475.22, "10th_percentile": 11475.22, "90th_percentile": 11475.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 8979.05, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 8979.05, "10th_percentile": 8979.05, "90th_percentile": 8979.05, "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", "standard_charge_dollar": 7721.98, "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": 7721.98, "10th_percentile": 7721.98, "90th_percentile": 7721.98, "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": 4202.19, "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": 4202.19, "10th_percentile": 4202.19, "90th_percentile": 4202.19, "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": 4202.19, "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": 4202.19, "10th_percentile": 4202.19, "90th_percentile": 4202.19, "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 SELECT", "standard_charge_dollar": 4202.19, "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": 4202.19, "10th_percentile": 4202.19, "90th_percentile": 4202.19, "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." } ] } ] }, { "description": "BASEPLATE TIB STEM CEM PERSONA SZ D 5DEG R", "code_information": [ { "code": "SUP-146058", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1068.14, "maximum": 6434.58, "setting": "outpatient", "gross_charge": 6434.58, "discounted_cash": 4504.21, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1068.14, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $6,434.58 @ 12.8% = $823.63 due to $0.00 Claim Price", "median_amount": 823.63, "10th_percentile": 823.63, "90th_percentile": 823.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,434.58 @ 12.8% = $823.63 due to $0.00 Claim Price" }, { "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "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": 5147.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5147.66, "10th_percentile": 5147.66, "90th_percentile": 5147.66, "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": 5147.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5147.66, "10th_percentile": 5147.66, "90th_percentile": 5147.66, "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": 1363.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1363.49, "10th_percentile": 1363.49, "90th_percentile": 1363.49, "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 HMO", "standard_charge_dollar": 1363.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1363.49, "10th_percentile": 1363.49, "90th_percentile": 1363.49, "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": 1756.64, "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": 1756.64, "10th_percentile": 1756.64, "90th_percentile": 1756.64, "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": 1756.64, "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": 1756.64, "10th_percentile": 1756.64, "90th_percentile": 1756.64, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6434.58, "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 $6,434.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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 $6,434.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "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": 3391.02, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 4111.7, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4111.7, "10th_percentile": 4111.7, "90th_percentile": 4111.7, "count": "0", "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": 1351.26, "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": 1351.26, "10th_percentile": 1351.26, "90th_percentile": 1351.26, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4132.93, "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": 4132.93, "10th_percentile": 4132.93, "90th_percentile": 4132.93, "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": 3049.99, "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": 3049.99, "10th_percentile": 3049.99, "90th_percentile": 3049.99, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2927.73, "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": 2927.73, "10th_percentile": 2927.73, "90th_percentile": 2927.73, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4954.63, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4954.63, "10th_percentile": 4954.63, "90th_percentile": 4954.63, "count": "0", "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": 5791.12, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5791.12, "10th_percentile": 5791.12, "90th_percentile": 5791.12, "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": 3217.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3217.29, "10th_percentile": 3217.29, "90th_percentile": 3217.29, "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 BROAD", "standard_charge_dollar": 3127.21, "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": 3127.21, "10th_percentile": 3127.21, "90th_percentile": 3127.21, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2766.87, "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": 2766.87, "10th_percentile": 2766.87, "90th_percentile": 2766.87, "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 OPTIONS", "standard_charge_dollar": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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 SELECT", "standard_charge_dollar": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "BASEPLATE TIB STEM CEM PERSONA SZ H 5DEG L", "code_information": [ { "code": "SUP-147637", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1068.14, "maximum": 6434.58, "setting": "outpatient", "gross_charge": 6434.58, "discounted_cash": 4504.21, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1068.14, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $6,434.58 @ 12.8% = $823.63 due to $0.00 Claim Price", "median_amount": 823.63, "10th_percentile": 823.63, "90th_percentile": 823.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,434.58 @ 12.8% = $823.63 due to $0.00 Claim Price" }, { "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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": 5147.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5147.66, "10th_percentile": 5147.66, "90th_percentile": 5147.66, "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": 5147.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5147.66, "10th_percentile": 5147.66, "90th_percentile": 5147.66, "count": "0", "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": 1363.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1363.49, "10th_percentile": 1363.49, "90th_percentile": 1363.49, "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": 1363.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1363.49, "10th_percentile": 1363.49, "90th_percentile": 1363.49, "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": 1756.64, "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": 1756.64, "10th_percentile": 1756.64, "90th_percentile": 1756.64, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1756.64, "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": 1756.64, "10th_percentile": 1756.64, "90th_percentile": 1756.64, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6434.58, "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 $6,434.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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 $6,434.58 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": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3391.02, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1351.26, "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": 1351.26, "10th_percentile": 1351.26, "90th_percentile": 1351.26, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 5791.12, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5791.12, "10th_percentile": 5791.12, "90th_percentile": 5791.12, "count": "0", "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": 3127.21, "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": 3127.21, "10th_percentile": 3127.21, "90th_percentile": 3127.21, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2927.73, "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": 2927.73, "10th_percentile": 2927.73, "90th_percentile": 2927.73, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4111.7, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4111.7, "10th_percentile": 4111.7, "90th_percentile": 4111.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3217.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3217.29, "10th_percentile": 3217.29, "90th_percentile": 3217.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4954.63, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4954.63, "10th_percentile": 4954.63, "90th_percentile": 4954.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2766.87, "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": 2766.87, "10th_percentile": 2766.87, "90th_percentile": 2766.87, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4132.93, "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": 4132.93, "10th_percentile": 4132.93, "90th_percentile": 4132.93, "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": 3049.99, "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": 3049.99, "10th_percentile": 3049.99, "90th_percentile": 3049.99, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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 SELECT", "standard_charge_dollar": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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." } ] } ] }, { "description": "BASEPLATE TIB STEM CEM PERSONA SZ H 5DEG R", "code_information": [ { "code": "SUP-147638", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 960.21, "maximum": 5784.42, "setting": "outpatient", "gross_charge": 5784.42, "discounted_cash": 4049.09, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 960.21, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "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": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "count": "0", "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": 4627.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4627.54, "10th_percentile": 4627.54, "90th_percentile": 4627.54, "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": 1225.72, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1225.72, "10th_percentile": 1225.72, "90th_percentile": 1225.72, "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 HMO", "standard_charge_dollar": 1225.72, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1225.72, "10th_percentile": 1225.72, "90th_percentile": 1225.72, "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": 1579.15, "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": 1579.15, "10th_percentile": 1579.15, "90th_percentile": 1579.15, "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": 1579.15, "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": 1579.15, "10th_percentile": 1579.15, "90th_percentile": 1579.15, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 5784.42, "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 $5,784.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "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 $5,784.42 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": 5784.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "count": "0", "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": 1214.73, "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": 1214.73, "10th_percentile": 1214.73, "90th_percentile": 1214.73, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2631.91, "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": 2631.91, "10th_percentile": 2631.91, "90th_percentile": 2631.91, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4454.0, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4454.0, "10th_percentile": 4454.0, "90th_percentile": 4454.0, "count": "0", "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": 2811.23, "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": 2811.23, "10th_percentile": 2811.23, "90th_percentile": 2811.23, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2487.3, "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": 2487.3, "10th_percentile": 2487.3, "90th_percentile": 2487.3, "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 OPTIONS", "standard_charge_dollar": 1353.55, "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": 1353.55, "10th_percentile": 1353.55, "90th_percentile": 1353.55, "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 SELECT", "standard_charge_dollar": 1353.55, "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": 1353.55, "10th_percentile": 1353.55, "90th_percentile": 1353.55, "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": 1353.55, "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": 1353.55, "10th_percentile": 1353.55, "90th_percentile": 1353.55, "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": "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: $5,784.42 @ 12.8% = $740.41 due to $0.00 Claim Price", "median_amount": 740.41, "10th_percentile": 740.41, "90th_percentile": 740.41, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $5,784.42 @ 12.8% = $740.41 due to $0.00 Claim Price" }, { "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": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "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": 4627.54, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4627.54, "10th_percentile": 4627.54, "90th_percentile": 4627.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 5784.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 5784.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 5784.42, "10th_percentile": 5784.42, "90th_percentile": 5784.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3048.39, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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 PPO", "standard_charge_dollar": 5205.98, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5205.98, "10th_percentile": 5205.98, "90th_percentile": 5205.98, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3696.24, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3696.24, "10th_percentile": 3696.24, "90th_percentile": 3696.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2892.21, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2892.21, "10th_percentile": 2892.21, "90th_percentile": 2892.21, "count": "0", "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": 3715.33, "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": 3715.33, "10th_percentile": 3715.33, "90th_percentile": 3715.33, "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": 2741.82, "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": 2741.82, "10th_percentile": 2741.82, "90th_percentile": 2741.82, "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." } ] } ] }, { "description": "BASEPLATE TIB SZ7 7MM ALL POLY CRUC RETAIN ATTUNE KN", "code_information": [ { "code": "SUP-421870", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1965.04, "maximum": 11837.61, "setting": "outpatient", "gross_charge": 11837.61, "discounted_cash": 8286.33, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1965.04, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "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": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 3231.67, "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": 3231.67, "10th_percentile": 3231.67, "90th_percentile": 3231.67, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "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": 2508.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2508.39, "10th_percentile": 2508.39, "90th_percentile": 2508.39, "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": 2508.39, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2508.39, "10th_percentile": 2508.39, "90th_percentile": 2508.39, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 11837.61, "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 $11,837.61 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "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 $11,837.61 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": 11837.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 5386.11, "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": 5386.11, "10th_percentile": 5386.11, "90th_percentile": 5386.11, "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": 5090.17, "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": 5090.17, "10th_percentile": 5090.17, "90th_percentile": 5090.17, "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": 2770.0, "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": 2770.0, "10th_percentile": 2770.0, "90th_percentile": 2770.0, "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": 2770.0, "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": 2770.0, "10th_percentile": 2770.0, "90th_percentile": 2770.0, "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 SELECT", "standard_charge_dollar": 2770.0, "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": 2770.0, "10th_percentile": 2770.0, "90th_percentile": 2770.0, "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": "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: $11,837.61 @ 12.8% = $1,515.21 due to $0.00 Claim Price", "median_amount": 1515.21, "10th_percentile": 1515.21, "90th_percentile": 1515.21, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $11,837.61 @ 12.8% = $1,515.21 due to $0.00 Claim Price" }, { "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": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "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": 9470.09, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "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": 3231.67, "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": 3231.67, "10th_percentile": 3231.67, "90th_percentile": 3231.67, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 11837.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 11837.61, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 11837.61, "10th_percentile": 11837.61, "90th_percentile": 11837.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 6238.42, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2485.9, "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": 2485.9, "10th_percentile": 2485.9, "90th_percentile": 2485.9, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 10653.85, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 10653.85, "10th_percentile": 10653.85, "90th_percentile": 10653.85, "count": "0", "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": 5753.08, "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": 5753.08, "10th_percentile": 5753.08, "90th_percentile": 5753.08, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 7564.23, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 7564.23, "10th_percentile": 7564.23, "90th_percentile": 7564.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 5918.81, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5918.81, "10th_percentile": 5918.81, "90th_percentile": 5918.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 9114.96, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 9114.96, "10th_percentile": 9114.96, "90th_percentile": 9114.96, "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": 7603.3, "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": 7603.3, "10th_percentile": 7603.3, "90th_percentile": 7603.3, "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": 5611.03, "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": 5611.03, "10th_percentile": 5611.03, "90th_percentile": 5611.03, "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." } ] } ] }, { "description": "BASEPLATE TIB TY INTLOK 79MM 141215", "code_information": [ { "code": "SUP-313761", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1068.14, "maximum": 6434.58, "setting": "outpatient", "gross_charge": 6434.58, "discounted_cash": 4504.21, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1068.14, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $6,434.58 @ 12.8% = $823.63 due to $0.00 Claim Price", "median_amount": 823.63, "10th_percentile": 823.63, "90th_percentile": 823.63, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $6,434.58 @ 12.8% = $823.63 due to $0.00 Claim Price" }, { "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "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": 5147.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5147.66, "10th_percentile": 5147.66, "90th_percentile": 5147.66, "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": 5147.66, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5147.66, "10th_percentile": 5147.66, "90th_percentile": 5147.66, "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": 1363.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1363.49, "10th_percentile": 1363.49, "90th_percentile": 1363.49, "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 HMO", "standard_charge_dollar": 1363.49, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1363.49, "10th_percentile": 1363.49, "90th_percentile": 1363.49, "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": 1756.64, "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": 1756.64, "10th_percentile": 1756.64, "90th_percentile": 1756.64, "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": 1756.64, "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": 1756.64, "10th_percentile": 1756.64, "90th_percentile": 1756.64, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 6434.58, "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 $6,434.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "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 $6,434.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 6434.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 6434.58, "10th_percentile": 6434.58, "90th_percentile": 6434.58, "count": "0", "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": 3391.02, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 4111.7, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4111.7, "10th_percentile": 4111.7, "90th_percentile": 4111.7, "count": "0", "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": 1351.26, "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": 1351.26, "10th_percentile": 1351.26, "90th_percentile": 1351.26, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4132.93, "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": 4132.93, "10th_percentile": 4132.93, "90th_percentile": 4132.93, "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": 3049.99, "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": 3049.99, "10th_percentile": 3049.99, "90th_percentile": 3049.99, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2927.73, "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": 2927.73, "10th_percentile": 2927.73, "90th_percentile": 2927.73, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4954.63, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 4954.63, "10th_percentile": 4954.63, "90th_percentile": 4954.63, "count": "0", "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": 5791.12, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5791.12, "10th_percentile": 5791.12, "90th_percentile": 5791.12, "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": 3217.29, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3217.29, "10th_percentile": 3217.29, "90th_percentile": 3217.29, "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 BROAD", "standard_charge_dollar": 3127.21, "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": 3127.21, "10th_percentile": 3127.21, "90th_percentile": 3127.21, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2766.87, "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": 2766.87, "10th_percentile": 2766.87, "90th_percentile": 2766.87, "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 OPTIONS", "standard_charge_dollar": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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 SELECT", "standard_charge_dollar": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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": 1505.69, "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": 1505.69, "10th_percentile": 1505.69, "90th_percentile": 1505.69, "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." } ] } ] }, { "description": "BASEPLATE TIBIA KNEE EMPOWR L SZ 8", "code_information": [ { "code": "SUP-340453", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2235.43, "maximum": 13466.47, "setting": "outpatient", "gross_charge": 13466.47, "discounted_cash": 9426.53, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2235.43, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $13,466.47 @ 12.8% = $1,723.71 due to $0.00 Claim Price", "median_amount": 1723.71, "10th_percentile": 1723.71, "90th_percentile": 1723.71, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $13,466.47 @ 12.8% = $1,723.71 due to $0.00 Claim Price" }, { "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": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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": 10773.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10773.18, "10th_percentile": 10773.18, "90th_percentile": 10773.18, "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": 10773.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10773.18, "10th_percentile": 10773.18, "90th_percentile": 10773.18, "count": "0", "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": 2853.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2853.54, "10th_percentile": 2853.54, "90th_percentile": 2853.54, "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": 2853.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2853.54, "10th_percentile": 2853.54, "90th_percentile": 2853.54, "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": 3676.35, "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": 3676.35, "10th_percentile": 3676.35, "90th_percentile": 3676.35, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 3676.35, "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": 3676.35, "10th_percentile": 3676.35, "90th_percentile": 3676.35, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 13466.47, "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 $13,466.47 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "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 $13,466.47 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": 13466.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 13466.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 13466.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 13466.47, "10th_percentile": 13466.47, "90th_percentile": 13466.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 7096.83, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2827.96, "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": 2827.96, "10th_percentile": 2827.96, "90th_percentile": 2827.96, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 12119.82, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 12119.82, "10th_percentile": 12119.82, "90th_percentile": 12119.82, "count": "0", "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": 6544.7, "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": 6544.7, "10th_percentile": 6544.7, "90th_percentile": 6544.7, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 6127.24, "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": 6127.24, "10th_percentile": 6127.24, "90th_percentile": 6127.24, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 8605.07, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 8605.07, "10th_percentile": 8605.07, "90th_percentile": 8605.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 6733.24, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6733.24, "10th_percentile": 6733.24, "90th_percentile": 6733.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 10369.18, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 10369.18, "10th_percentile": 10369.18, "90th_percentile": 10369.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 5790.58, "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": 5790.58, "10th_percentile": 5790.58, "90th_percentile": 5790.58, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 8649.51, "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": 8649.51, "10th_percentile": 8649.51, "90th_percentile": 8649.51, "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": 6383.11, "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": 6383.11, "10th_percentile": 6383.11, "90th_percentile": 6383.11, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 3151.15, "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": 3151.15, "10th_percentile": 3151.15, "90th_percentile": 3151.15, "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": 3151.15, "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": 3151.15, "10th_percentile": 3151.15, "90th_percentile": 3151.15, "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 SELECT", "standard_charge_dollar": 3151.15, "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": 3151.15, "10th_percentile": 3151.15, "90th_percentile": 3151.15, "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." } ] } ] }, { "description": "BASEPLATE TIBIAL CMTD UNIV REVISION SIZE 1 STEMMED 10/17MM", "code_information": [ { "code": "SUP-371098", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 6135.3, "maximum": 36959.65, "setting": "outpatient", "gross_charge": 36959.65, "discounted_cash": 25871.75, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 6135.3, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $36,959.65 @ 12.8% = $4,730.84 due to $0.00 Claim Price", "median_amount": 4730.84, "10th_percentile": 4730.84, "90th_percentile": 4730.84, "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: $36,959.65 @ 12.8% = $4,730.84 due to $0.00 Claim Price" }, { "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": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "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": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "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": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "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": 29567.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 29567.72, "10th_percentile": 29567.72, "90th_percentile": 29567.72, "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": 29567.72, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 29567.72, "10th_percentile": 29567.72, "90th_percentile": 29567.72, "count": "0", "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": 7831.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 7831.75, "10th_percentile": 7831.75, "90th_percentile": 7831.75, "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": 7831.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 7831.75, "10th_percentile": 7831.75, "90th_percentile": 7831.75, "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": 10089.98, "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": 10089.98, "10th_percentile": 10089.98, "90th_percentile": 10089.98, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 10089.98, "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": 10089.98, "10th_percentile": 10089.98, "90th_percentile": 10089.98, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 36959.65, "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 $36,959.65 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "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 $36,959.65 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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 36959.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 36959.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 36959.65, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 36959.65, "10th_percentile": 36959.65, "90th_percentile": 36959.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 19477.74, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 7761.53, "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": 7761.53, "10th_percentile": 7761.53, "90th_percentile": 7761.53, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 33263.69, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 33263.69, "10th_percentile": 33263.69, "90th_percentile": 33263.69, "count": "0", "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": 17962.39, "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": 17962.39, "10th_percentile": 17962.39, "90th_percentile": 17962.39, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 16816.64, "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": 16816.64, "10th_percentile": 16816.64, "90th_percentile": 16816.64, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 23617.22, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 23617.22, "10th_percentile": 23617.22, "90th_percentile": 23617.22, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 18479.83, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 18479.83, "10th_percentile": 18479.83, "90th_percentile": 18479.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 28458.93, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 28458.93, "10th_percentile": 28458.93, "90th_percentile": 28458.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 15892.65, "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": 15892.65, "10th_percentile": 15892.65, "90th_percentile": 15892.65, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 23739.18, "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": 23739.18, "10th_percentile": 23739.18, "90th_percentile": 23739.18, "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": 17518.87, "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": 17518.87, "10th_percentile": 17518.87, "90th_percentile": 17518.87, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8648.56, "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": 8648.56, "10th_percentile": 8648.56, "90th_percentile": 8648.56, "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": 8648.56, "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": 8648.56, "10th_percentile": 8648.56, "90th_percentile": 8648.56, "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 SELECT", "standard_charge_dollar": 8648.56, "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": 8648.56, "10th_percentile": 8648.56, "90th_percentile": 8648.56, "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." } ] } ] }, { "description": "BASKET MEM 7FR SFT WRE 3X6CM DISPO", "code_information": [ { "code": "SUP-351968", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 343.52, "maximum": 2069.39, "setting": "outpatient", "gross_charge": 2069.39, "discounted_cash": 1448.57, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1655.51, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1655.51, "10th_percentile": 1655.51, "90th_percentile": 1655.51, "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": 1655.51, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1655.51, "10th_percentile": 1655.51, "90th_percentile": 1655.51, "count": "0", "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": 565.15, "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": 565.15, "10th_percentile": 565.15, "90th_percentile": 565.15, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 565.15, "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": 565.15, "10th_percentile": 565.15, "90th_percentile": 565.15, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 438.5, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 438.5, "10th_percentile": 438.5, "90th_percentile": 438.5, "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 HMO", "standard_charge_dollar": 438.5, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 438.5, "10th_percentile": 438.5, "90th_percentile": 438.5, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2069.39, "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 $2,069.39 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "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 $2,069.39 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 455.47, "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": 455.47, "10th_percentile": 455.47, "90th_percentile": 455.47, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 931.23, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 931.23, "10th_percentile": 931.23, "90th_percentile": 931.23, "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 OPTIONS", "standard_charge_dollar": 481.55, "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": 481.55, "10th_percentile": 481.55, "90th_percentile": 481.55, "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 BLUECHOICE SELECT", "standard_charge_dollar": 433.74, "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": 433.74, "10th_percentile": 433.74, "90th_percentile": 433.74, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1329.17, "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": 1329.17, "10th_percentile": 1329.17, "90th_percentile": 1329.17, "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 BROAD", "standard_charge_dollar": 1005.72, "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": 1005.72, "10th_percentile": 1005.72, "90th_percentile": 1005.72, "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": 1696.9, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1696.9, "10th_percentile": 1696.9, "90th_percentile": 1696.9, "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": 1034.7, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1034.7, "10th_percentile": 1034.7, "90th_percentile": 1034.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2069.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 343.52, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 343.52, "10th_percentile": 343.52, "90th_percentile": 343.52, "count": "0", "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": 980.89, "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": 980.89, "10th_percentile": 980.89, "90th_percentile": 980.89, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 941.57, "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": 941.57, "10th_percentile": 941.57, "90th_percentile": 941.57, "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": 1090.57, "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": 1090.57, "10th_percentile": 1090.57, "90th_percentile": 1090.57, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2069.39, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 434.57, "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": 434.57, "10th_percentile": 434.57, "90th_percentile": 434.57, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1322.34, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1322.34, "10th_percentile": 1322.34, "90th_percentile": 1322.34, "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": 889.84, "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": 889.84, "10th_percentile": 889.84, "90th_percentile": 889.84, "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": 1862.45, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1862.45, "10th_percentile": 1862.45, "90th_percentile": 1862.45, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "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": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "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": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "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": 2069.39, "10th_percentile": 2069.39, "90th_percentile": 2069.39, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BASKET ZERO TIP NITINOL STONE RETRIEVAL 1.9FR M0063901050", "code_information": [ { "code": "SUP-104215", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 632.67, "maximum": 3811.29, "setting": "outpatient", "gross_charge": 3811.29, "discounted_cash": 2667.9, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3049.03, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3049.03, "10th_percentile": 3049.03, "90th_percentile": 3049.03, "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": 3049.03, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3049.03, "10th_percentile": 3049.03, "90th_percentile": 3049.03, "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 HMO", "standard_charge_dollar": 807.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 807.61, "10th_percentile": 807.61, "90th_percentile": 807.61, "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 HMO", "standard_charge_dollar": 807.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 807.61, "10th_percentile": 807.61, "90th_percentile": 807.61, "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": 1040.86, "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": 1040.86, "10th_percentile": 1040.86, "90th_percentile": 1040.86, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1040.86, "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": 1040.86, "10th_percentile": 1040.86, "90th_percentile": 1040.86, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3811.29, "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 $3,811.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "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 $3,811.29 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 BLUECHOICE PREFERRED", "standard_charge_dollar": 838.86, "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": 838.86, "10th_percentile": 838.86, "90th_percentile": 838.86, "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": 798.85, "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": 798.85, "10th_percentile": 798.85, "90th_percentile": 798.85, "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": 886.89, "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": 886.89, "10th_percentile": 886.89, "90th_percentile": 886.89, "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": 1715.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1715.08, "10th_percentile": 1715.08, "90th_percentile": 1715.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 1905.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1905.65, "10th_percentile": 1905.65, "90th_percentile": 1905.65, "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", "standard_charge_dollar": 1638.85, "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": 1638.85, "10th_percentile": 1638.85, "90th_percentile": 1638.85, "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": 632.67, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 632.67, "10th_percentile": 632.67, "90th_percentile": 632.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3430.16, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3430.16, "10th_percentile": 3430.16, "90th_percentile": 3430.16, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2435.41, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2435.41, "10th_percentile": 2435.41, "90th_percentile": 2435.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3125.26, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 3125.26, "10th_percentile": 3125.26, "90th_percentile": 3125.26, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1852.29, "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": 1852.29, "10th_percentile": 1852.29, "90th_percentile": 1852.29, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1806.55, "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": 1806.55, "10th_percentile": 1806.55, "90th_percentile": 1806.55, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3811.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2447.99, "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": 2447.99, "10th_percentile": 2447.99, "90th_percentile": 2447.99, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3811.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 800.37, "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": 800.37, "10th_percentile": 800.37, "90th_percentile": 800.37, "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 ASA", "standard_charge_dollar": 1734.14, "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": 1734.14, "10th_percentile": 1734.14, "90th_percentile": 1734.14, "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": 2008.55, "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": 2008.55, "10th_percentile": 2008.55, "90th_percentile": 2008.55, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "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": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "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": 3811.29, "10th_percentile": 3811.29, "90th_percentile": 3811.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BATTERY PACK STERILE (05.000.007.01S)", "code_information": [ { "code": "SUP-125714", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 422.7, "maximum": 2546.4, "setting": "outpatient", "gross_charge": 2546.4, "discounted_cash": 1782.48, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 695.42, "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": 695.42, "10th_percentile": 695.42, "90th_percentile": 695.42, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 695.42, "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": 695.42, "10th_percentile": 695.42, "90th_percentile": 695.42, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 539.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 539.58, "10th_percentile": 539.58, "90th_percentile": 539.58, "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 HMO", "standard_charge_dollar": 539.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 539.58, "10th_percentile": 539.58, "90th_percentile": 539.58, "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": 2037.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2037.12, "10th_percentile": 2037.12, "90th_percentile": 2037.12, "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": 2037.12, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2037.12, "10th_percentile": 2037.12, "90th_percentile": 2037.12, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 2546.4, "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 $2,546.40 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "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 $2,546.40 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": 592.55, "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": 592.55, "10th_percentile": 592.55, "90th_percentile": 592.55, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 560.46, "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": 560.46, "10th_percentile": 560.46, "90th_percentile": 560.46, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1145.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1145.88, "10th_percentile": 1145.88, "90th_percentile": 1145.88, "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": 533.73, "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": 533.73, "10th_percentile": 533.73, "90th_percentile": 533.73, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2291.76, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2291.76, "10th_percentile": 2291.76, "90th_percentile": 2291.76, "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": 1273.2, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1273.2, "10th_percentile": 1273.2, "90th_percentile": 1273.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2088.05, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2088.05, "10th_percentile": 2088.05, "90th_percentile": 2088.05, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1237.55, "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": 1237.55, "10th_percentile": 1237.55, "90th_percentile": 1237.55, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 1627.15, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1627.15, "10th_percentile": 1627.15, "90th_percentile": 1627.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 2546.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 422.7, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 422.7, "10th_percentile": 422.7, "90th_percentile": 422.7, "count": "0", "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": 1635.55, "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": 1635.55, "10th_percentile": 1635.55, "90th_percentile": 1635.55, "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": 534.74, "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": 534.74, "10th_percentile": 534.74, "90th_percentile": 534.74, "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": 1094.95, "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": 1094.95, "10th_percentile": 1094.95, "90th_percentile": 1094.95, "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 ASA", "standard_charge_dollar": 1158.61, "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": 1158.61, "10th_percentile": 1158.61, "90th_percentile": 1158.61, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "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": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "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": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "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": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1206.99, "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": 1206.99, "10th_percentile": 1206.99, "90th_percentile": 1206.99, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 2546.4, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 2546.4, "10th_percentile": 2546.4, "90th_percentile": 2546.4, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 1341.95, "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": 1341.95, "10th_percentile": 1341.95, "90th_percentile": 1341.95, "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." } ] } ] }, { "description": "BEARING HUMERAL 40MM STD PRLNG 110031421", "code_information": [ { "code": "SUP-345702", "type": "CDM" }, { "code": "C1776", "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": "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": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $8,330.17 @ 12.8% = $1,066.26 due to $0.00 Claim Price", "median_amount": 1066.26, "10th_percentile": 1066.26, "90th_percentile": 1066.26, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $8,330.17 @ 12.8% = $1,066.26 due to $0.00 Claim Price" }, { "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": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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 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": 2274.14, "10th_percentile": 2274.14, "90th_percentile": 2274.14, "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": 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": 2274.14, "10th_percentile": 2274.14, "90th_percentile": 2274.14, "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": "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": 6664.14, "10th_percentile": 6664.14, "90th_percentile": 6664.14, "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": 6664.14, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6664.14, "10th_percentile": 6664.14, "90th_percentile": 6664.14, "count": "0", "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": 1765.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1765.16, "10th_percentile": 1765.16, "90th_percentile": 1765.16, "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": 1765.16, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1765.16, "10th_percentile": 1765.16, "90th_percentile": 1765.16, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 8330.17, "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 $8,330.17 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "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 $8,330.17 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 8330.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 8330.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 8330.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 8330.17, "10th_percentile": 8330.17, "90th_percentile": 8330.17, "count": "0", "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": 4390.0, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "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": 3948.5, "10th_percentile": 3948.5, "90th_percentile": 3948.5, "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": 6414.23, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 6414.23, "10th_percentile": 6414.23, "90th_percentile": 6414.23, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "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": 1749.34, "10th_percentile": 1749.34, "90th_percentile": 1749.34, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 7497.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 7497.15, "10th_percentile": 7497.15, "90th_percentile": 7497.15, "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": 3790.23, "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": 3790.23, "10th_percentile": 3790.23, "90th_percentile": 3790.23, "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": "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": 5350.47, "10th_percentile": 5350.47, "90th_percentile": 5350.47, "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 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": 4048.46, "10th_percentile": 4048.46, "90th_percentile": 4048.46, "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": "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": 5322.98, "10th_percentile": 5322.98, "90th_percentile": 5322.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "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": 4165.09, "10th_percentile": 4165.09, "90th_percentile": 4165.09, "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", "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": 3581.97, "10th_percentile": 3581.97, "90th_percentile": 3581.97, "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": 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": 1949.26, "10th_percentile": 1949.26, "90th_percentile": 1949.26, "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": 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": 1949.26, "10th_percentile": 1949.26, "90th_percentile": 1949.26, "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 SELECT", "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": 1949.26, "10th_percentile": 1949.26, "90th_percentile": 1949.26, "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." } ] } ] }, { "description": "BEARING PSN PK CMT TIB LM SZ F", "code_information": [ { "code": "SUP-346903", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1283.22, "maximum": 7730.24, "setting": "outpatient", "gross_charge": 7730.24, "discounted_cash": 5411.17, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1283.22, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,730.24 @ 12.8% = $989.47 due to $0.00 Claim Price", "median_amount": 989.47, "10th_percentile": 989.47, "90th_percentile": 989.47, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,730.24 @ 12.8% = $989.47 due to $0.00 Claim Price" }, { "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": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "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": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "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": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "count": "0", "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": 6184.19, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6184.19, "10th_percentile": 6184.19, "90th_percentile": 6184.19, "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": 6184.19, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6184.19, "10th_percentile": 6184.19, "90th_percentile": 6184.19, "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": 1638.04, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1638.04, "10th_percentile": 1638.04, "90th_percentile": 1638.04, "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 HMO", "standard_charge_dollar": 1638.04, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1638.04, "10th_percentile": 1638.04, "90th_percentile": 1638.04, "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": 2110.36, "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": 2110.36, "10th_percentile": 2110.36, "90th_percentile": 2110.36, "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": 2110.36, "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": 2110.36, "10th_percentile": 2110.36, "90th_percentile": 2110.36, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7730.24, "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 $7,730.24 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "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 $7,730.24 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7730.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7730.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7730.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7730.24, "10th_percentile": 7730.24, "90th_percentile": 7730.24, "count": "0", "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": 4073.84, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": 4939.62, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4939.62, "10th_percentile": 4939.62, "90th_percentile": 4939.62, "count": "0", "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": 1623.35, "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": 1623.35, "10th_percentile": 1623.35, "90th_percentile": 1623.35, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4965.13, "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": 4965.13, "10th_percentile": 4965.13, "90th_percentile": 4965.13, "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": 3664.13, "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": 3664.13, "10th_percentile": 3664.13, "90th_percentile": 3664.13, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3517.26, "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": 3517.26, "10th_percentile": 3517.26, "90th_percentile": 3517.26, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5952.28, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5952.28, "10th_percentile": 5952.28, "90th_percentile": 5952.28, "count": "0", "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": 6957.22, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6957.22, "10th_percentile": 6957.22, "90th_percentile": 6957.22, "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": 3865.12, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3865.12, "10th_percentile": 3865.12, "90th_percentile": 3865.12, "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 BROAD", "standard_charge_dollar": 3756.9, "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": 3756.9, "10th_percentile": 3756.9, "90th_percentile": 3756.9, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3324.0, "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": 3324.0, "10th_percentile": 3324.0, "90th_percentile": 3324.0, "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 OPTIONS", "standard_charge_dollar": 1808.88, "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": 1808.88, "10th_percentile": 1808.88, "90th_percentile": 1808.88, "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 SELECT", "standard_charge_dollar": 1808.88, "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": 1808.88, "10th_percentile": 1808.88, "90th_percentile": 1808.88, "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": 1808.88, "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": 1808.88, "10th_percentile": 1808.88, "90th_percentile": 1808.88, "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." } ] } ] }, { "description": "BEARING TIB 11X63/67MM KN E1 CRUCIATE RETAINING VANGUARD", "code_information": [ { "code": "SUP-358998", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1164.47, "maximum": 7014.88, "setting": "outpatient", "gross_charge": 7014.88, "discounted_cash": 4910.42, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1164.47, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,014.88 @ 12.8% = $897.90 due to $0.00 Claim Price", "median_amount": 897.9, "10th_percentile": 897.9, "90th_percentile": 897.9, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,014.88 @ 12.8% = $897.90 due to $0.00 Claim Price" }, { "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": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "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": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "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": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "count": "0", "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": 5611.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "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": 5611.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5611.9, "10th_percentile": 5611.9, "90th_percentile": 5611.9, "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": 1486.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1486.45, "10th_percentile": 1486.45, "90th_percentile": 1486.45, "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 HMO", "standard_charge_dollar": 1486.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1486.45, "10th_percentile": 1486.45, "90th_percentile": 1486.45, "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": 1915.06, "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": 1915.06, "10th_percentile": 1915.06, "90th_percentile": 1915.06, "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": 1915.06, "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": 1915.06, "10th_percentile": 1915.06, "90th_percentile": 1915.06, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7014.88, "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 $7,014.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "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 $7,014.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7014.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 7014.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4482.51, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4482.51, "10th_percentile": 4482.51, "90th_percentile": 4482.51, "count": "0", "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": 1473.12, "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": 1473.12, "10th_percentile": 1473.12, "90th_percentile": 1473.12, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3191.77, "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": 3191.77, "10th_percentile": 3191.77, "90th_percentile": 3191.77, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5401.46, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5401.46, "10th_percentile": 5401.46, "90th_percentile": 5401.46, "count": "0", "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": 6313.39, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6313.39, "10th_percentile": 6313.39, "90th_percentile": 6313.39, "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": 3507.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3507.44, "10th_percentile": 3507.44, "90th_percentile": 3507.44, "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 BROAD", "standard_charge_dollar": 3409.23, "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": 3409.23, "10th_percentile": 3409.23, "90th_percentile": 3409.23, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3016.4, "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": 3016.4, "10th_percentile": 3016.4, "90th_percentile": 3016.4, "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 OPTIONS", "standard_charge_dollar": 1641.48, "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": 1641.48, "10th_percentile": 1641.48, "90th_percentile": 1641.48, "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 SELECT", "standard_charge_dollar": 1641.48, "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": 1641.48, "10th_percentile": 1641.48, "90th_percentile": 1641.48, "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": 1641.48, "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": 1641.48, "10th_percentile": 1641.48, "90th_percentile": 1641.48, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7014.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7014.88, "10th_percentile": 7014.88, "90th_percentile": 7014.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3696.84, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3325.05, "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": 3325.05, "10th_percentile": 3325.05, "90th_percentile": 3325.05, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4505.66, "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": 4505.66, "10th_percentile": 4505.66, "90th_percentile": 4505.66, "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." } ] } ] }, { "description": "BEARING TIB 79/83MM 10MM KN PSTR STBL VANGUARD VIVACIT-E", "code_information": [ { "code": "SUP-309898", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 1207.74, "maximum": 7275.52, "setting": "outpatient", "gross_charge": 7275.52, "discounted_cash": 5092.86, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1207.74, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $7,275.52 @ 12.8% = $931.27 due to $0.00 Claim Price", "median_amount": 931.27, "10th_percentile": 931.27, "90th_percentile": 931.27, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $7,275.52 @ 12.8% = $931.27 due to $0.00 Claim Price" }, { "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": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "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": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "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": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "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": 5820.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5820.42, "10th_percentile": 5820.42, "90th_percentile": 5820.42, "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": 5820.42, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 5820.42, "10th_percentile": 5820.42, "90th_percentile": 5820.42, "count": "0", "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": 1541.68, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1541.68, "10th_percentile": 1541.68, "90th_percentile": 1541.68, "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": 1541.68, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1541.68, "10th_percentile": 1541.68, "90th_percentile": 1541.68, "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": 1986.22, "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": 1986.22, "10th_percentile": 1986.22, "90th_percentile": 1986.22, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1986.22, "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": 1986.22, "10th_percentile": 1986.22, "90th_percentile": 1986.22, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 7275.52, "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 $7,275.52 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "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 $7,275.52 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": 7275.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7275.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7275.52, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7275.52, "10th_percentile": 7275.52, "90th_percentile": 7275.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 3834.2, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1527.86, "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": 1527.86, "10th_percentile": 1527.86, "90th_percentile": 1527.86, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 6547.97, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 6547.97, "10th_percentile": 6547.97, "90th_percentile": 6547.97, "count": "0", "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": 3535.9, "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": 3535.9, "10th_percentile": 3535.9, "90th_percentile": 3535.9, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 3310.36, "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": 3310.36, "10th_percentile": 3310.36, "90th_percentile": 3310.36, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 4649.06, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 4649.06, "10th_percentile": 4649.06, "90th_percentile": 4649.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3637.76, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3637.76, "10th_percentile": 3637.76, "90th_percentile": 3637.76, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 5602.15, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 5602.15, "10th_percentile": 5602.15, "90th_percentile": 5602.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 3128.47, "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": 3128.47, "10th_percentile": 3128.47, "90th_percentile": 3128.47, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 4673.07, "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": 4673.07, "10th_percentile": 4673.07, "90th_percentile": 4673.07, "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": 3448.6, "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": 3448.6, "10th_percentile": 3448.6, "90th_percentile": 3448.6, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 1702.47, "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": 1702.47, "10th_percentile": 1702.47, "90th_percentile": 1702.47, "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": 1702.47, "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": 1702.47, "10th_percentile": 1702.47, "90th_percentile": 1702.47, "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 SELECT", "standard_charge_dollar": 1702.47, "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": 1702.47, "10th_percentile": 1702.47, "90th_percentile": 1702.47, "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." } ] } ] }, { "description": "BEARING VIVACIT-E 36MM STD RET", "code_information": [ { "code": "SUP-446079", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2110.6, "maximum": 12714.47, "setting": "outpatient", "gross_charge": 12714.47, "discounted_cash": 8900.13, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2110.6, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $12,714.47 @ 12.8% = $1,627.45 due to $0.00 Claim Price", "median_amount": 1627.45, "10th_percentile": 1627.45, "90th_percentile": 1627.45, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $12,714.47 @ 12.8% = $1,627.45 due to $0.00 Claim Price" }, { "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": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "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": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "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": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "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 PPO", "standard_charge_dollar": 3471.05, "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": 3471.05, "10th_percentile": 3471.05, "90th_percentile": 3471.05, "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": 3471.05, "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": 3471.05, "10th_percentile": 3471.05, "90th_percentile": 3471.05, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 10171.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10171.58, "10th_percentile": 10171.58, "90th_percentile": 10171.58, "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": 10171.58, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 10171.58, "10th_percentile": 10171.58, "90th_percentile": 10171.58, "count": "0", "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": 2694.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2694.2, "10th_percentile": 2694.2, "90th_percentile": 2694.2, "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": 2694.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2694.2, "10th_percentile": 2694.2, "90th_percentile": 2694.2, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 12714.47, "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 $12,714.47 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "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 $12,714.47 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 12714.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 12714.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 12714.47, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 12714.47, "10th_percentile": 12714.47, "90th_percentile": 12714.47, "count": "0", "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": 6700.53, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 6026.66, "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": 6026.66, "10th_percentile": 6026.66, "90th_percentile": 6026.66, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 9790.14, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 9790.14, "10th_percentile": 9790.14, "90th_percentile": 9790.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2670.04, "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": 2670.04, "10th_percentile": 2670.04, "90th_percentile": 2670.04, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 11443.02, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 11443.02, "10th_percentile": 11443.02, "90th_percentile": 11443.02, "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": 5785.08, "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": 5785.08, "10th_percentile": 5785.08, "90th_percentile": 5785.08, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 8166.5, "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": 8166.5, "10th_percentile": 8166.5, "90th_percentile": 8166.5, "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 BROAD", "standard_charge_dollar": 6179.23, "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": 6179.23, "10th_percentile": 6179.23, "90th_percentile": 6179.23, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 8124.55, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 8124.55, "10th_percentile": 8124.55, "90th_percentile": 8124.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 6357.24, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 6357.24, "10th_percentile": 6357.24, "90th_percentile": 6357.24, "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", "standard_charge_dollar": 5467.22, "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": 5467.22, "10th_percentile": 5467.22, "90th_percentile": 5467.22, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2975.19, "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": 2975.19, "10th_percentile": 2975.19, "90th_percentile": 2975.19, "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": 2975.19, "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": 2975.19, "10th_percentile": 2975.19, "90th_percentile": 2975.19, "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 SELECT", "standard_charge_dollar": 2975.19, "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": 2975.19, "10th_percentile": 2975.19, "90th_percentile": 2975.19, "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." } ] } ] }, { "description": "BEARING/BUSHG KT ULN REV DISCVR", "code_information": [ { "code": "SUP-153262", "type": "CDM" }, { "code": "C1776", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 2455.58, "maximum": 14792.63, "setting": "outpatient", "gross_charge": 14792.63, "discounted_cash": 10354.84, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 2455.58, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1697.0, "10th_percentile": 1697.0, "90th_percentile": 1697.0, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $14,792.63 @ 12.8% = $1,893.46 due to $0.00 Claim Price", "median_amount": 1893.46, "10th_percentile": 1893.46, "90th_percentile": 1893.46, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $14,792.63 @ 12.8% = $1,893.46 due to $0.00 Claim Price" }, { "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": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "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": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "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": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "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 PPO", "standard_charge_dollar": 4038.39, "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": 4038.39, "10th_percentile": 4038.39, "90th_percentile": 4038.39, "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": 4038.39, "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": 4038.39, "10th_percentile": 4038.39, "90th_percentile": 4038.39, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 11834.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11834.1, "10th_percentile": 11834.1, "90th_percentile": 11834.1, "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": 11834.1, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 11834.1, "10th_percentile": 11834.1, "90th_percentile": 11834.1, "count": "0", "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": 3134.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3134.56, "10th_percentile": 3134.56, "90th_percentile": 3134.56, "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": 3134.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3134.56, "10th_percentile": 3134.56, "90th_percentile": 3134.56, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 14792.63, "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 $14,792.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "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 $14,792.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 14792.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 14792.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 14792.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 14792.63, "10th_percentile": 14792.63, "90th_percentile": 14792.63, "count": "0", "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": 7795.72, "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": 2683.49, "10th_percentile": 2683.49, "90th_percentile": 2683.49, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 7011.71, "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": 7011.71, "10th_percentile": 7011.71, "90th_percentile": 7011.71, "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": 11390.33, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 11390.33, "10th_percentile": 11390.33, "90th_percentile": 11390.33, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 3106.45, "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": 3106.45, "10th_percentile": 3106.45, "90th_percentile": 3106.45, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 13313.37, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 13313.37, "10th_percentile": 13313.37, "90th_percentile": 13313.37, "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": 6730.65, "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": 6730.65, "10th_percentile": 6730.65, "90th_percentile": 6730.65, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 9501.31, "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": 9501.31, "10th_percentile": 9501.31, "90th_percentile": 9501.31, "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 BROAD", "standard_charge_dollar": 7189.22, "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": 7189.22, "10th_percentile": 7189.22, "90th_percentile": 7189.22, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 9452.49, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 9452.49, "10th_percentile": 9452.49, "90th_percentile": 9452.49, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 7396.32, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 7396.32, "10th_percentile": 7396.32, "90th_percentile": 7396.32, "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", "standard_charge_dollar": 6360.83, "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": 6360.83, "10th_percentile": 6360.83, "90th_percentile": 6360.83, "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": 3461.48, "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": 3461.48, "10th_percentile": 3461.48, "90th_percentile": 3461.48, "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": 3461.48, "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": 3461.48, "10th_percentile": 3461.48, "90th_percentile": 3461.48, "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 SELECT", "standard_charge_dollar": 3461.48, "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": 3461.48, "10th_percentile": 3461.48, "90th_percentile": 3461.48, "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." } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 5179.14, "maximum": 10501.49, "setting": "inpatient", "gross_charge": 28897.5, "discounted_cash": 20228.25, "payers_information": [ { "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, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 28899.25, "10th_percentile": 28899.25, "90th_percentile": 28899.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services - OON; 100% Billed", "median_amount": 28899.25, "10th_percentile": 28899.25, "90th_percentile": 28899.25, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; 100% Billed", "median_amount": 28899.25, "10th_percentile": 28899.25, "90th_percentile": 28899.25, "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.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; Inpatient Services; 50% Billed", "median_amount": 14449.63, "10th_percentile": 14449.63, "90th_percentile": 14449.63, "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.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; 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": 8785.37, "10th_percentile": 8785.37, "90th_percentile": 8785.37, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; IP Services; 65% Billed", "median_amount": 18784.51, "10th_percentile": 18784.51, "90th_percentile": 18784.51, "count": "1 through 10", "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 drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 24564.36, "10th_percentile": 24564.36, "90th_percentile": 24564.36, "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, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 4797.29, "10th_percentile": 4797.29, "90th_percentile": 4797.29, "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, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "median_amount": 20807.46, "10th_percentile": 20807.46, "90th_percentile": 20807.46, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 10501.49, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10501.49, "10th_percentile": 10501.49, "90th_percentile": 10501.49, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 7991.1, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7991.1, "10th_percentile": 7991.1, "90th_percentile": 7991.1, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 8994.68, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 12,458.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE STOP LOSS & LESSOR OF 9*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8994.68, "10th_percentile": 8994.68, "90th_percentile": 8994.68, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 8574.47, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 11,876.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE PREF STOP LOSS & LESSOR*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8574.47, "10th_percentile": 8574.47, "90th_percentile": 8574.47, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 8406.25, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 11,643.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS BLUECHOICE SELECT STOP LOSS & LESS*; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 8406.25, "10th_percentile": 8406.25, "90th_percentile": 8406.25, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 10501.49, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 14,545.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS PPO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 10501.49, "10th_percentile": 10501.49, "90th_percentile": 10501.49, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 7991.1, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 0.7220, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 7991.1, "10th_percentile": 7991.1, "90th_percentile": 7991.1, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 5179.14, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,554.79; Total: $6,554.79", "median_amount": 6554.79, "10th_percentile": 6554.79, "90th_percentile": 6554.79, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,554.79; Total: $6,554.79" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_dollar": 5179.14, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,554.79; Total: $6,554.79", "median_amount": 6554.79, "10th_percentile": 6554.79, "90th_percentile": 6554.79, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $6,554.79; Total: $6,554.79" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_dollar": 5179.14, "standard_charge_algorithm": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $5,612.40; Total: $5,612.40 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 5612.4, "10th_percentile": 5612.4, "90th_percentile": 5612.4, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.833490033; Using historical claim(s); Scope: All Financial Classes; Cases: 4; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 0.72, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $5,612.40; Total: $5,612.40 Paid at contractual rate, which is 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": "BENZOCAINE 20 % MM AEROSOL SPRAY", "drug_information": { "unit": 57.0, "type": "GR" }, "code_information": [ { "code": "RX-4080000155", "type": "CDM" }, { "code": "25000000", "type": "LOCAL" }, { "code": "0250", "type": "RC" }, { "code": "00699-3100-02", "type": "NDC" } ], "standard_charges": [ { "minimum": 71.96, "maximum": 433.5, "setting": "outpatient", "gross_charge": 433.5, "discounted_cash": 303.45, "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": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "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": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "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": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "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": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 186.41, "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": 186.41, "10th_percentile": 186.41, "90th_percentile": 186.41, "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 ASA", "standard_charge_dollar": 197.24, "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": 197.24, "10th_percentile": 197.24, "90th_percentile": 197.24, "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 NM EMPLOYEES", "standard_charge_dollar": 71.96, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 71.96, "10th_percentile": 71.96, "90th_percentile": 71.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 91.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 91.86, "10th_percentile": 91.86, "90th_percentile": 91.86, "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": 118.39, "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": 118.39, "10th_percentile": 118.39, "90th_percentile": 118.39, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 346.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 346.8, "10th_percentile": 346.8, "90th_percentile": 346.8, "count": "0", "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": 195.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 195.08, "10th_percentile": 195.08, "90th_percentile": 195.08, "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 OPTIONS", "standard_charge_dollar": 100.88, "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": 100.88, "10th_percentile": 100.88, "90th_percentile": 100.88, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 95.41, "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": 95.41, "10th_percentile": 95.41, "90th_percentile": 95.41, "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": 90.86, "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": 90.86, "10th_percentile": 90.86, "90th_percentile": 90.86, "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 HMO", "standard_charge_dollar": 91.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 91.86, "10th_percentile": 91.86, "90th_percentile": 91.86, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 433.5, "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 $433.50 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "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 $433.50 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 PPO", "standard_charge_dollar": 118.39, "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": 118.39, "10th_percentile": 118.39, "90th_percentile": 118.39, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 91.04, "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": 91.04, "10th_percentile": 91.04, "90th_percentile": 91.04, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 210.68, "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": 210.68, "10th_percentile": 210.68, "90th_percentile": 210.68, "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": 355.47, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 355.47, "10th_percentile": 355.47, "90th_percentile": 355.47, "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": 277.01, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 277.01, "10th_percentile": 277.01, "90th_percentile": 277.01, "count": "0", "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": 390.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 390.15, "10th_percentile": 390.15, "90th_percentile": 390.15, "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": 216.75, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 216.75, "10th_percentile": 216.75, "90th_percentile": 216.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 433.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 346.8, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 346.8, "10th_percentile": 346.8, "90th_percentile": 346.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 278.44, "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": 278.44, "10th_percentile": 278.44, "90th_percentile": 278.44, "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": 205.48, "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": 205.48, "10th_percentile": 205.48, "90th_percentile": 205.48, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 228.45, "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": 228.45, "10th_percentile": 228.45, "90th_percentile": 228.45, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 433.5, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 433.5, "10th_percentile": 433.5, "90th_percentile": 433.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "BER II Catheter 5Fr 65cm", "code_information": [ { "code": "SUP-341544", "type": "CDM" }, { "code": "C1887", "type": "CPT" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 21.76, "maximum": 131.09, "setting": "outpatient", "gross_charge": 131.09, "discounted_cash": 91.76, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 69.08, "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": 97.53, "10th_percentile": 97.53, "90th_percentile": 97.53, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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: $131.09 @ 12.8% = $16.78 due to $0.00 Claim Price", "median_amount": 16.78, "10th_percentile": 16.78, "90th_percentile": 16.78, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $131.09 @ 12.8% = $16.78 due to $0.00 Claim Price" }, { "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": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "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": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "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": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "count": "0", "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": 56.37, "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": 56.37, "10th_percentile": 56.37, "90th_percentile": 56.37, "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 BROAD", "standard_charge_dollar": 63.71, "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": 105.27, "10th_percentile": 105.27, "90th_percentile": 105.27, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 117.98, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 117.98, "10th_percentile": 117.98, "90th_percentile": 117.98, "count": "0", "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": 27.53, "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": 27.53, "10th_percentile": 27.53, "90th_percentile": 27.53, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 84.2, "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": 84.2, "10th_percentile": 84.2, "90th_percentile": 84.2, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 65.55, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 65.55, "10th_percentile": 65.55, "90th_percentile": 65.55, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 83.77, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 83.77, "10th_percentile": 83.77, "90th_percentile": 83.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 107.49, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 107.49, "10th_percentile": 107.49, "90th_percentile": 107.49, "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 $19,355 CASE RATE" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 21.76, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 21.76, "10th_percentile": 21.76, "90th_percentile": 21.76, "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 ASA", "standard_charge_dollar": 59.65, "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": 59.65, "10th_percentile": 59.65, "90th_percentile": 59.65, "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 CORE", "standard_charge_dollar": 62.14, "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": 62.14, "10th_percentile": 62.14, "90th_percentile": 62.14, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 58.99, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 58.99, "10th_percentile": 58.99, "90th_percentile": 58.99, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 131.09, "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 $131.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "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 $131.09 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 131.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 131.09, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 131.09, "10th_percentile": 131.09, "90th_percentile": 131.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 104.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 104.87, "10th_percentile": 104.87, "90th_percentile": 104.87, "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": 104.87, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 104.87, "10th_percentile": 104.87, "90th_percentile": 104.87, "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": 27.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 27.78, "10th_percentile": 27.78, "90th_percentile": 27.78, "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 HMO", "standard_charge_dollar": 27.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 27.78, "10th_percentile": 27.78, "90th_percentile": 27.78, "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": 35.79, "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": 35.79, "10th_percentile": 35.79, "90th_percentile": 35.79, "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": 35.79, "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": 35.79, "10th_percentile": 35.79, "90th_percentile": 35.79, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 30.68, "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": 30.68, "10th_percentile": 30.68, "90th_percentile": 30.68, "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": 30.68, "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": 30.68, "10th_percentile": 30.68, "90th_percentile": 30.68, "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 SELECT", "standard_charge_dollar": 30.68, "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": 30.68, "10th_percentile": 30.68, "90th_percentile": 30.68, "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." } ] } ] }, { "description": "BERN 5F 0.038INX125CM CATH PERI DIAG 1SD PORT", "code_information": [ { "code": "SUP-355795", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 91.7, "maximum": 552.42, "setting": "outpatient", "gross_charge": 552.42, "discounted_cash": 386.69, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 441.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 441.94, "10th_percentile": 441.94, "90th_percentile": 441.94, "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": 441.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 441.94, "10th_percentile": 441.94, "90th_percentile": 441.94, "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": 117.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 117.06, "10th_percentile": 117.06, "90th_percentile": 117.06, "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 HMO", "standard_charge_dollar": 117.06, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 117.06, "10th_percentile": 117.06, "90th_percentile": 117.06, "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": 150.87, "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": 150.87, "10th_percentile": 150.87, "90th_percentile": 150.87, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 150.87, "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": 150.87, "10th_percentile": 150.87, "90th_percentile": 150.87, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 552.42, "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 $552.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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 $552.42 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 121.59, "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": 121.59, "10th_percentile": 121.59, "90th_percentile": 121.59, "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": 115.79, "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": 115.79, "10th_percentile": 115.79, "90th_percentile": 115.79, "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": 128.55, "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": 128.55, "10th_percentile": 128.55, "90th_percentile": 128.55, "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": 248.59, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 248.59, "10th_percentile": 248.59, "90th_percentile": 248.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 276.21, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 276.21, "10th_percentile": 276.21, "90th_percentile": 276.21, "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", "standard_charge_dollar": 237.54, "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": 237.54, "10th_percentile": 237.54, "90th_percentile": 237.54, "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": 91.7, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 91.7, "10th_percentile": 91.7, "90th_percentile": 91.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 497.18, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 497.18, "10th_percentile": 497.18, "90th_percentile": 497.18, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 353.0, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 353.0, "10th_percentile": 353.0, "90th_percentile": 353.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 452.98, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 452.98, "10th_percentile": 452.98, "90th_percentile": 452.98, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 268.48, "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": 268.48, "10th_percentile": 268.48, "90th_percentile": 268.48, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 261.85, "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": 261.85, "10th_percentile": 261.85, "90th_percentile": 261.85, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 552.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 354.82, "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": 354.82, "10th_percentile": 354.82, "90th_percentile": 354.82, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 552.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 116.01, "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": 116.01, "10th_percentile": 116.01, "90th_percentile": 116.01, "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 ASA", "standard_charge_dollar": 251.35, "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": 251.35, "10th_percentile": 251.35, "90th_percentile": 251.35, "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": 291.13, "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": 291.13, "10th_percentile": 291.13, "90th_percentile": 291.13, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "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": 552.42, "10th_percentile": 552.42, "90th_percentile": 552.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BINDER BREAST LG BLU 933015BLUE/LG", "code_information": [ { "code": "SUP-310672", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 45.6, "maximum": 274.68, "setting": "outpatient", "gross_charge": 274.68, "discounted_cash": 192.28, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 274.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 144.76, "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": 144.76, "10th_percentile": 144.76, "90th_percentile": 144.76, "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": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "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": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "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": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "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": 219.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 219.74, "10th_percentile": 219.74, "90th_percentile": 219.74, "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": 219.74, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 219.74, "10th_percentile": 219.74, "90th_percentile": 219.74, "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": 58.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 58.2, "10th_percentile": 58.2, "90th_percentile": 58.2, "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 HMO", "standard_charge_dollar": 58.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 58.2, "10th_percentile": 58.2, "90th_percentile": 58.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 274.68, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 274.68, "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 $274.68 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 274.68, "10th_percentile": 274.68, "90th_percentile": 274.68, "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 $274.68 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 137.34, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 137.34, "10th_percentile": 137.34, "90th_percentile": 137.34, "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": 247.21, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 247.21, "10th_percentile": 247.21, "90th_percentile": 247.21, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 175.52, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 175.52, "10th_percentile": 175.52, "90th_percentile": 175.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 123.61, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 123.61, "10th_percentile": 123.61, "90th_percentile": 123.61, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 130.2, "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": 130.2, "10th_percentile": 130.2, "90th_percentile": 130.2, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 60.46, "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": 60.46, "10th_percentile": 60.46, "90th_percentile": 60.46, "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": 63.92, "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": 63.92, "10th_percentile": 63.92, "90th_percentile": 63.92, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 176.43, "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": 176.43, "10th_percentile": 176.43, "90th_percentile": 176.43, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 45.6, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 45.6, "10th_percentile": 45.6, "90th_percentile": 45.6, "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 ALTERNATIVE", "standard_charge_dollar": 57.68, "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": 57.68, "10th_percentile": 57.68, "90th_percentile": 57.68, "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": 118.11, "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": 118.11, "10th_percentile": 118.11, "90th_percentile": 118.11, "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 BROAD", "standard_charge_dollar": 133.49, "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": 133.49, "10th_percentile": 133.49, "90th_percentile": 133.49, "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": 225.24, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 225.24, "10th_percentile": 225.24, "90th_percentile": 225.24, "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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 57.57, "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": 57.57, "10th_percentile": 57.57, "90th_percentile": 57.57, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 124.98, "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": 124.98, "10th_percentile": 124.98, "90th_percentile": 124.98, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 75.02, "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": 75.02, "10th_percentile": 75.02, "90th_percentile": 75.02, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 75.02, "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": 75.02, "10th_percentile": 75.02, "90th_percentile": 75.02, "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." } ] } ] }, { "description": "BIOPATCH DRESSING (4150)", "code_information": [ { "code": "SUP-304467", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 24.9, "maximum": 150.03, "setting": "outpatient", "gross_charge": 150.03, "discounted_cash": 105.02, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 40.97, "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": 40.97, "10th_percentile": 40.97, "90th_percentile": 40.97, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 40.97, "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": 40.97, "10th_percentile": 40.97, "90th_percentile": 40.97, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 31.79, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 31.79, "10th_percentile": 31.79, "90th_percentile": 31.79, "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 HMO", "standard_charge_dollar": 31.79, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 31.79, "10th_percentile": 31.79, "90th_percentile": 31.79, "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": 120.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 120.02, "10th_percentile": 120.02, "90th_percentile": 120.02, "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": 120.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 120.02, "10th_percentile": 120.02, "90th_percentile": 120.02, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 150.03, "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 $150.03 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "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 $150.03 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 OPTIONS", "standard_charge_dollar": 34.91, "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": 34.91, "10th_percentile": 34.91, "90th_percentile": 34.91, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 33.02, "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": 33.02, "10th_percentile": 33.02, "90th_percentile": 33.02, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 67.51, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 67.51, "10th_percentile": 67.51, "90th_percentile": 67.51, "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": 31.45, "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": 31.45, "10th_percentile": 31.45, "90th_percentile": 31.45, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 135.03, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 135.03, "10th_percentile": 135.03, "90th_percentile": 135.03, "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": 75.02, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 75.02, "10th_percentile": 75.02, "90th_percentile": 75.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 123.02, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 123.02, "10th_percentile": 123.02, "90th_percentile": 123.02, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 72.91, "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": 72.91, "10th_percentile": 72.91, "90th_percentile": 72.91, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 150.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 95.87, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 95.87, "10th_percentile": 95.87, "90th_percentile": 95.87, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 150.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 24.9, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 24.9, "10th_percentile": 24.9, "90th_percentile": 24.9, "count": "0", "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": 96.36, "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": 96.36, "10th_percentile": 96.36, "90th_percentile": 96.36, "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": 79.07, "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": 79.07, "10th_percentile": 79.07, "90th_percentile": 79.07, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 71.11, "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": 71.11, "10th_percentile": 71.11, "90th_percentile": 71.11, "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": 31.51, "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": 31.51, "10th_percentile": 31.51, "90th_percentile": 31.51, "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": 64.51, "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": 64.51, "10th_percentile": 64.51, "90th_percentile": 64.51, "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 ASA", "standard_charge_dollar": 68.26, "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": 68.26, "10th_percentile": 68.26, "90th_percentile": 68.26, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "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": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "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": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "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": 150.03, "10th_percentile": 150.03, "90th_percentile": 150.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 13334.49, "maximum": 20574.31, "setting": "inpatient", "gross_charge": 54891.39, "discounted_cash": 38423.97, "payers_information": [ { "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, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 54891.38, "10th_percentile": 54891.38, "90th_percentile": 54891.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All IP Services - OON; 100% Billed", "median_amount": 54891.38, "10th_percentile": 54891.38, "90th_percentile": 54891.38, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_percentage": 100.0, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All IP Services; 100% Billed", "median_amount": 54891.38, "10th_percentile": 54891.38, "90th_percentile": 54891.38, "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.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; Inpatient Services; 50% Billed", "median_amount": 27445.69, "10th_percentile": 27445.69, "90th_percentile": 27445.69, "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 anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 9111.97, "10th_percentile": 9111.97, "90th_percentile": 9111.97, "count": "1 through 10", "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, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 46657.69, "10th_percentile": 46657.69, "90th_percentile": 46657.69, "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 anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "median_amount": 39521.79, "10th_percentile": 39521.79, "90th_percentile": 39521.79, "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.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; 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": 16686.98, "10th_percentile": 16686.98, "90th_percentile": 16686.98, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "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.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; IP Services; 65% Billed", "median_amount": 35679.4, "10th_percentile": 35679.4, "90th_percentile": 35679.4, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE OPTIONS", "standard_charge_percentage": 28.5, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; IP Services. ADP RATE (for patient estimates only); 28.5% 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": 15644.04, "10th_percentile": 15644.04, "90th_percentile": 15644.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_percentage": 28.5, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; IP Services. ADP RATE (for patient estimates only); 28.5% 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": 15644.04, "10th_percentile": 15644.04, "90th_percentile": 15644.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_percentage": 28.5, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; IP Services. ADP RATE (for patient estimates only); 28.5% 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": 15644.04, "10th_percentile": 15644.04, "90th_percentile": 15644.04, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_percentage": 33.8, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; IP Services. ADP RATE (for patient estimates only); 33.8% 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": 18553.29, "10th_percentile": 18553.29, "90th_percentile": 18553.29, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_percentage": 33.8, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; IP Services. ADP RATE (for patient estimates only); 33.8% 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": 18553.29, "10th_percentile": 18553.29, "90th_percentile": 18553.29, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 20574.31, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20574.31, "10th_percentile": 20574.31, "90th_percentile": 20574.31, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 20574.31, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All IP Services; Weighted FSC: NM HB MEDICARE ACUTE WEIGHTED, Weight: 1.8589, Rate: 11,068.00, and; Pricing Extension - NM HB XR PRC - NLFH BCBS HMO STOP LOSS & LESSOR OF 9.1.25; Note: Multiple pricing methods applied. Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 20574.31, "10th_percentile": 20574.31, "90th_percentile": 20574.31, "count": "1 through 10", "methodology": "case rate" }, { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_dollar": 13334.49, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $15,542.49; Total: $15,542.49", "median_amount": 15542.49, "10th_percentile": 15542.49, "90th_percentile": 15542.49, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All DRGs (Plans excl O-IME); FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $15,542.49; Total: $15,542.49" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_dollar": 13334.49, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $15,542.49; Total: $15,542.49", "median_amount": 15542.49, "10th_percentile": 15542.49, "90th_percentile": 15542.49, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALCULATION EXCL O-IME; Note: Base payment: $15,542.49; Total: $15,542.49" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_dollar": 13334.49, "standard_charge_algorithm": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $14,449.99; Total: $14,449.99 Paid at contractual rate, which is the lesser of contractual and 100% of charges. Total pmt for all lines paid so far is less than 100% of claim billed amount.", "median_amount": 14449.99, "10th_percentile": 14449.99, "90th_percentile": 14449.99, "count": "1 through 10", "methodology": "other", "additional_payer_notes": "Re-evaluated: HLB.831827906; Using new claim; Scope: All Financial Classes; Cases: 3; All DRGs; FSC: NM HB MEDICARE ACUTE WEIGHTED, Value: 1.86, and; Pricing Extension - NM HB XR PRC - MEDICARE IP DRG CALC EXCL O-IME & LESSOR OF; Note: Multiple pricing methods applied. Base payment: $14,449.99; Total: $14,449.99 Paid at contractual rate, which is 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": "BIOPSY PUNCH ACUDERM 2.0MM", "code_information": [ { "code": "SUP-9041766", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 6.78, "maximum": 40.86, "setting": "outpatient", "gross_charge": 40.86, "discounted_cash": 28.6, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 32.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 32.69, "10th_percentile": 32.69, "90th_percentile": 32.69, "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": 32.69, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 32.69, "10th_percentile": 32.69, "90th_percentile": 32.69, "count": "0", "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": 11.16, "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": 11.16, "10th_percentile": 11.16, "90th_percentile": 11.16, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 11.16, "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": 11.16, "10th_percentile": 11.16, "90th_percentile": 11.16, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 8.66, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 8.66, "10th_percentile": 8.66, "90th_percentile": 8.66, "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 HMO", "standard_charge_dollar": 8.66, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 8.66, "10th_percentile": 8.66, "90th_percentile": 8.66, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 40.86, "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 $40.86 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "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 $40.86 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 BLUECHOICE PREFERRED", "standard_charge_dollar": 8.99, "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": 8.99, "10th_percentile": 8.99, "90th_percentile": 8.99, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 18.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 18.39, "10th_percentile": 18.39, "90th_percentile": 18.39, "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 OPTIONS", "standard_charge_dollar": 9.51, "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": 9.51, "10th_percentile": 9.51, "90th_percentile": 9.51, "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 BLUECHOICE SELECT", "standard_charge_dollar": 8.56, "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": 8.56, "10th_percentile": 8.56, "90th_percentile": 8.56, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 26.24, "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": 26.24, "10th_percentile": 26.24, "90th_percentile": 26.24, "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 BROAD", "standard_charge_dollar": 19.86, "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": 19.86, "10th_percentile": 19.86, "90th_percentile": 19.86, "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": 33.51, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 33.51, "10th_percentile": 33.51, "90th_percentile": 33.51, "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": 20.43, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 20.43, "10th_percentile": 20.43, "90th_percentile": 20.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 40.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 6.78, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 6.78, "10th_percentile": 6.78, "90th_percentile": 6.78, "count": "0", "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": 19.37, "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": 19.37, "10th_percentile": 19.37, "90th_percentile": 19.37, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 18.59, "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": 18.59, "10th_percentile": 18.59, "90th_percentile": 18.59, "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": 21.53, "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": 21.53, "10th_percentile": 21.53, "90th_percentile": 21.53, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 40.86, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 8.58, "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": 8.58, "10th_percentile": 8.58, "90th_percentile": 8.58, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 26.11, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 26.11, "10th_percentile": 26.11, "90th_percentile": 26.11, "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": 17.57, "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": 17.57, "10th_percentile": 17.57, "90th_percentile": 17.57, "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": 36.77, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 36.77, "10th_percentile": 36.77, "90th_percentile": 36.77, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "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": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "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": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "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": 40.86, "10th_percentile": 40.86, "90th_percentile": 40.86, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIOPSY PUNCH DERMAL 2MM (33-31)", "code_information": [ { "code": "SUP-9063416", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 3.02, "maximum": 18.2, "setting": "outpatient", "gross_charge": 18.2, "discounted_cash": 12.74, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 14.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.56, "10th_percentile": 14.56, "90th_percentile": 14.56, "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": 14.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 14.56, "10th_percentile": 14.56, "90th_percentile": 14.56, "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": 3.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.86, "10th_percentile": 3.86, "90th_percentile": 3.86, "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 HMO", "standard_charge_dollar": 3.86, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 3.86, "10th_percentile": 3.86, "90th_percentile": 3.86, "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": 4.97, "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": 4.97, "10th_percentile": 4.97, "90th_percentile": 4.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 4.97, "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": 4.97, "10th_percentile": 4.97, "90th_percentile": 4.97, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 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 PAR/INDEMNITY ADP", "standard_charge_dollar": 18.2, "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 $18.20 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "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 $18.20 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": 4.01, "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": 4.01, "10th_percentile": 4.01, "90th_percentile": 4.01, "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": 3.81, "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": 3.81, "10th_percentile": 3.81, "90th_percentile": 3.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "No historical claim; OP All Other; 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": 4.24, "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": 4.24, "10th_percentile": 4.24, "90th_percentile": 4.24, "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": 8.19, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 8.19, "10th_percentile": 8.19, "90th_percentile": 8.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 9.1, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 9.1, "10th_percentile": 9.1, "90th_percentile": 9.1, "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", "standard_charge_dollar": 7.83, "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": 7.83, "10th_percentile": 7.83, "90th_percentile": 7.83, "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": 3.02, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 3.02, "10th_percentile": 3.02, "90th_percentile": 3.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 16.38, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 16.38, "10th_percentile": 16.38, "90th_percentile": 16.38, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 11.63, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 11.63, "10th_percentile": 11.63, "90th_percentile": 11.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 14.92, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 14.92, "10th_percentile": 14.92, "90th_percentile": 14.92, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 8.85, "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": 8.85, "10th_percentile": 8.85, "90th_percentile": 8.85, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 8.63, "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": 8.63, "10th_percentile": 8.63, "90th_percentile": 8.63, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 18.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 11.69, "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": 11.69, "10th_percentile": 11.69, "90th_percentile": 11.69, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 18.2, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 3.82, "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": 3.82, "10th_percentile": 3.82, "90th_percentile": 3.82, "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 ASA", "standard_charge_dollar": 8.28, "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": 8.28, "10th_percentile": 8.28, "90th_percentile": 8.28, "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": 9.59, "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": 9.59, "10th_percentile": 9.59, "90th_percentile": 9.59, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "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": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "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": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "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": 18.2, "10th_percentile": 18.2, "90th_percentile": 18.2, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIOSYN 2-0 KV-34 30IN UD CM827", "code_information": [ { "code": "SUP-380944", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 13.54, "maximum": 81.55, "setting": "outpatient", "gross_charge": 81.55, "discounted_cash": 57.08, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 65.24, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 65.24, "10th_percentile": 65.24, "90th_percentile": 65.24, "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": 65.24, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 65.24, "10th_percentile": 65.24, "90th_percentile": 65.24, "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": 17.28, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 17.28, "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 HMO", "standard_charge_dollar": 17.28, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 17.28, "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": 22.27, "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": 22.27, "10th_percentile": 22.27, "90th_percentile": 22.27, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 22.27, "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": 22.27, "10th_percentile": 22.27, "90th_percentile": 22.27, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 81.55, "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 $81.55 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "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 $81.55 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 PREFERRED", "standard_charge_dollar": 17.95, "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": 17.95, "10th_percentile": 17.95, "90th_percentile": 17.95, "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": 17.09, "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": 17.09, "10th_percentile": 17.09, "90th_percentile": 17.09, "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": 18.98, "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": 18.98, "10th_percentile": 18.98, "90th_percentile": 18.98, "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": 36.7, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 36.7, "10th_percentile": 36.7, "90th_percentile": 36.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 40.78, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 40.78, "10th_percentile": 40.78, "90th_percentile": 40.78, "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", "standard_charge_dollar": 35.07, "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": 35.07, "10th_percentile": 35.07, "90th_percentile": 35.07, "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": 13.54, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 73.4, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 73.4, "10th_percentile": 73.4, "90th_percentile": 73.4, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 52.11, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 52.11, "10th_percentile": 52.11, "90th_percentile": 52.11, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 66.87, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 66.87, "10th_percentile": 66.87, "90th_percentile": 66.87, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 39.63, "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": 39.63, "10th_percentile": 39.63, "90th_percentile": 39.63, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 38.65, "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": 38.65, "10th_percentile": 38.65, "90th_percentile": 38.65, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 81.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 52.38, "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": 52.38, "10th_percentile": 52.38, "90th_percentile": 52.38, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 81.55, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 17.13, "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": 17.13, "10th_percentile": 17.13, "90th_percentile": 17.13, "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 ASA", "standard_charge_dollar": 37.11, "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": 37.11, "10th_percentile": 37.11, "90th_percentile": 37.11, "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": 42.98, "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": 42.98, "10th_percentile": 42.98, "90th_percentile": 42.98, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "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": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "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": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "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": 81.55, "10th_percentile": 81.55, "90th_percentile": 81.55, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 1.5X85MM 310.15", "code_information": [ { "code": "SUP-161406", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 89.55, "maximum": 539.44, "setting": "outpatient", "gross_charge": 539.44, "discounted_cash": 377.61, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 147.32, "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": 147.32, "10th_percentile": 147.32, "90th_percentile": 147.32, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 147.32, "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": 147.32, "10th_percentile": 147.32, "90th_percentile": 147.32, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 114.31, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 114.31, "10th_percentile": 114.31, "90th_percentile": 114.31, "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 HMO", "standard_charge_dollar": 114.31, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 114.31, "10th_percentile": 114.31, "90th_percentile": 114.31, "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": 431.55, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 431.55, "10th_percentile": 431.55, "90th_percentile": 431.55, "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": 431.55, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 431.55, "10th_percentile": 431.55, "90th_percentile": 431.55, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 539.44, "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 $539.44 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "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 $539.44 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": 125.53, "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": 125.53, "10th_percentile": 125.53, "90th_percentile": 125.53, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 118.73, "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": 118.73, "10th_percentile": 118.73, "90th_percentile": 118.73, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 242.75, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 242.75, "10th_percentile": 242.75, "90th_percentile": 242.75, "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": 113.07, "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": 113.07, "10th_percentile": 113.07, "90th_percentile": 113.07, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 485.5, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 485.5, "10th_percentile": 485.5, "90th_percentile": 485.5, "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": 269.72, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 269.72, "10th_percentile": 269.72, "90th_percentile": 269.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 442.34, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 442.34, "10th_percentile": 442.34, "90th_percentile": 442.34, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 262.17, "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": 262.17, "10th_percentile": 262.17, "90th_percentile": 262.17, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 539.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 344.7, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 344.7, "10th_percentile": 344.7, "90th_percentile": 344.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 539.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 89.55, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 89.55, "10th_percentile": 89.55, "90th_percentile": 89.55, "count": "0", "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": 346.48, "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": 346.48, "10th_percentile": 346.48, "90th_percentile": 346.48, "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": 284.28, "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": 284.28, "10th_percentile": 284.28, "90th_percentile": 284.28, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 255.69, "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": 255.69, "10th_percentile": 255.69, "90th_percentile": 255.69, "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": 113.28, "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": 113.28, "10th_percentile": 113.28, "90th_percentile": 113.28, "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": 231.96, "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": 231.96, "10th_percentile": 231.96, "90th_percentile": 231.96, "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 ASA", "standard_charge_dollar": 245.45, "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": 245.45, "10th_percentile": 245.45, "90th_percentile": 245.45, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "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": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "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": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "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": 539.44, "10th_percentile": 539.44, "90th_percentile": 539.44, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 1.6X95MM CANN SELF TAPPING COMPRESS DRILL-1.6/095C", "code_information": [ { "code": "SUP-344794", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 215.43, "maximum": 1297.75, "setting": "outpatient", "gross_charge": 1297.75, "discounted_cash": 908.42, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1038.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1038.2, "10th_percentile": 1038.2, "90th_percentile": 1038.2, "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": 1038.2, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1038.2, "10th_percentile": 1038.2, "90th_percentile": 1038.2, "count": "0", "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": 354.42, "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": 354.42, "10th_percentile": 354.42, "90th_percentile": 354.42, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 354.42, "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": 354.42, "10th_percentile": 354.42, "90th_percentile": 354.42, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 274.99, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 274.99, "10th_percentile": 274.99, "90th_percentile": 274.99, "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 HMO", "standard_charge_dollar": 274.99, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 274.99, "10th_percentile": 274.99, "90th_percentile": 274.99, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1297.75, "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 $1,297.75 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "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 $1,297.75 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 285.63, "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": 285.63, "10th_percentile": 285.63, "90th_percentile": 285.63, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 583.99, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 583.99, "10th_percentile": 583.99, "90th_percentile": 583.99, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 301.99, "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": 301.99, "10th_percentile": 301.99, "90th_percentile": 301.99, "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 BCBS BLUECHOICE SELECT", "standard_charge_dollar": 272.01, "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": 272.01, "10th_percentile": 272.01, "90th_percentile": 272.01, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 833.54, "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": 833.54, "10th_percentile": 833.54, "90th_percentile": 833.54, "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 BROAD", "standard_charge_dollar": 630.71, "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": 630.71, "10th_percentile": 630.71, "90th_percentile": 630.71, "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": 1064.16, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1064.16, "10th_percentile": 1064.16, "90th_percentile": 1064.16, "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": 648.88, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 648.88, "10th_percentile": 648.88, "90th_percentile": 648.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1297.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 215.43, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 215.43, "10th_percentile": 215.43, "90th_percentile": 215.43, "count": "0", "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": 615.13, "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": 615.13, "10th_percentile": 615.13, "90th_percentile": 615.13, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 590.48, "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": 590.48, "10th_percentile": 590.48, "90th_percentile": 590.48, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 683.91, "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": 683.91, "10th_percentile": 683.91, "90th_percentile": 683.91, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1297.75, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 272.53, "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": 272.53, "10th_percentile": 272.53, "90th_percentile": 272.53, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 829.26, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 829.26, "10th_percentile": 829.26, "90th_percentile": 829.26, "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": 558.03, "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": 558.03, "10th_percentile": 558.03, "90th_percentile": 558.03, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1167.98, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1167.98, "10th_percentile": 1167.98, "90th_percentile": 1167.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "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": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "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": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "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": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 13MM TI ALLOY ACP SPINAL PLATE 7786713", "code_information": [ { "code": "SUP-377525", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 131.0, "maximum": 789.17, "setting": "outpatient", "gross_charge": 789.17, "discounted_cash": 552.42, "payers_information": [ { "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": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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": 631.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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": 167.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 167.23, "10th_percentile": 167.23, "90th_percentile": 167.23, "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 HMO", "standard_charge_dollar": 167.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 167.23, "10th_percentile": 167.23, "90th_percentile": 167.23, "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": 215.52, "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": 215.52, "10th_percentile": 215.52, "90th_percentile": 215.52, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 215.52, "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": 215.52, "10th_percentile": 215.52, "90th_percentile": 215.52, "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 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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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 $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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 173.7, "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": 173.7, "10th_percentile": 173.7, "90th_percentile": 173.7, "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": 165.41, "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": 165.41, "10th_percentile": 165.41, "90th_percentile": 165.41, "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": 183.64, "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": 183.64, "10th_percentile": 183.64, "90th_percentile": 183.64, "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": 355.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 355.13, "10th_percentile": 355.13, "90th_percentile": 355.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% 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": 394.59, "10th_percentile": 394.59, "90th_percentile": 394.59, "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", "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": 339.34, "10th_percentile": 339.34, "90th_percentile": 339.34, "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": 131.0, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 131.0, "10th_percentile": 131.0, "90th_percentile": 131.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "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": 710.25, "10th_percentile": 710.25, "90th_percentile": 710.25, "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": "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": 504.28, "10th_percentile": 504.28, "90th_percentile": 504.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 647.12, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 647.12, "10th_percentile": 647.12, "90th_percentile": 647.12, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 383.54, "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": 383.54, "10th_percentile": 383.54, "90th_percentile": 383.54, "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": "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": 374.07, "10th_percentile": 374.07, "90th_percentile": 374.07, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 789.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "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": 506.88, "10th_percentile": 506.88, "90th_percentile": 506.88, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 789.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 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": "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": 165.73, "10th_percentile": 165.73, "90th_percentile": 165.73, "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 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": 359.07, "10th_percentile": 359.07, "90th_percentile": 359.07, "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": 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": 415.89, "10th_percentile": 415.89, "90th_percentile": 415.89, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 2.45MM 10DEG ANGLED NONCANN INSERTION PHALINX 45303145", "code_information": [ { "code": "SUP-316172", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 272.2, "maximum": 1639.73, "setting": "outpatient", "gross_charge": 1639.73, "discounted_cash": 1147.81, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1311.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1311.78, "10th_percentile": 1311.78, "90th_percentile": 1311.78, "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": 1311.78, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1311.78, "10th_percentile": 1311.78, "90th_percentile": 1311.78, "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": 347.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 347.46, "10th_percentile": 347.46, "90th_percentile": 347.46, "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 HMO", "standard_charge_dollar": 347.46, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 347.46, "10th_percentile": 347.46, "90th_percentile": 347.46, "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": 447.81, "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": 447.81, "10th_percentile": 447.81, "90th_percentile": 447.81, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 447.81, "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": 447.81, "10th_percentile": 447.81, "90th_percentile": 447.81, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1639.73, "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 $1,639.73 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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 $1,639.73 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": 360.9, "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": 360.9, "10th_percentile": 360.9, "90th_percentile": 360.9, "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": 343.69, "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": 343.69, "10th_percentile": 343.69, "90th_percentile": 343.69, "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": 381.57, "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": 381.57, "10th_percentile": 381.57, "90th_percentile": 381.57, "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": 737.88, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 737.88, "10th_percentile": 737.88, "90th_percentile": 737.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 819.87, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 819.87, "10th_percentile": 819.87, "90th_percentile": 819.87, "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", "standard_charge_dollar": 705.08, "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": 705.08, "10th_percentile": 705.08, "90th_percentile": 705.08, "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": 272.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 272.2, "10th_percentile": 272.2, "90th_percentile": 272.2, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1475.76, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1475.76, "10th_percentile": 1475.76, "90th_percentile": 1475.76, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1047.79, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1047.79, "10th_percentile": 1047.79, "90th_percentile": 1047.79, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1344.58, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1344.58, "10th_percentile": 1344.58, "90th_percentile": 1344.58, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 796.91, "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": 796.91, "10th_percentile": 796.91, "90th_percentile": 796.91, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1053.2, "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": 1053.2, "10th_percentile": 1053.2, "90th_percentile": 1053.2, "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": 344.34, "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": 344.34, "10th_percentile": 344.34, "90th_percentile": 344.34, "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 ASA", "standard_charge_dollar": 746.08, "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": 746.08, "10th_percentile": 746.08, "90th_percentile": 746.08, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "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": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 777.23, "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": 777.23, "10th_percentile": 777.23, "90th_percentile": 777.23, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 864.14, "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": 864.14, "10th_percentile": 864.14, "90th_percentile": 864.14, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1639.73, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1639.73, "10th_percentile": 1639.73, "90th_percentile": 1639.73, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "BIT DRILL 3.2MM STRL 321-52-07", "code_information": [ { "code": "SUP-344730", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 515.14, "maximum": 3103.24, "setting": "outpatient", "gross_charge": 3103.24, "discounted_cash": 2172.27, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 2482.59, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2482.59, "10th_percentile": 2482.59, "90th_percentile": 2482.59, "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": 2482.59, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2482.59, "10th_percentile": 2482.59, "90th_percentile": 2482.59, "count": "0", "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": 847.49, "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": 847.49, "10th_percentile": 847.49, "90th_percentile": 847.49, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 847.49, "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": 847.49, "10th_percentile": 847.49, "90th_percentile": 847.49, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 657.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 657.58, "10th_percentile": 657.58, "90th_percentile": 657.58, "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 HMO", "standard_charge_dollar": 657.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 657.58, "10th_percentile": 657.58, "90th_percentile": 657.58, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3103.24, "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 $3,103.24 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "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 $3,103.24 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": 683.02, "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": 683.02, "10th_percentile": 683.02, "90th_percentile": 683.02, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1396.46, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1396.46, "10th_percentile": 1396.46, "90th_percentile": 1396.46, "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 OPTIONS", "standard_charge_dollar": 722.12, "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": 722.12, "10th_percentile": 722.12, "90th_percentile": 722.12, "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 BLUECHOICE SELECT", "standard_charge_dollar": 650.44, "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": 650.44, "10th_percentile": 650.44, "90th_percentile": 650.44, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1993.21, "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": 1993.21, "10th_percentile": 1993.21, "90th_percentile": 1993.21, "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 BROAD", "standard_charge_dollar": 1508.17, "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": 1508.17, "10th_percentile": 1508.17, "90th_percentile": 1508.17, "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": 2544.66, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2544.66, "10th_percentile": 2544.66, "90th_percentile": 2544.66, "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": 1551.62, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1551.62, "10th_percentile": 1551.62, "90th_percentile": 1551.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3103.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 515.14, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 515.14, "10th_percentile": 515.14, "90th_percentile": 515.14, "count": "0", "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": 1470.94, "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": 1470.94, "10th_percentile": 1470.94, "90th_percentile": 1470.94, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1411.97, "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": 1411.97, "10th_percentile": 1411.97, "90th_percentile": 1411.97, "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": 1635.41, "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": 1635.41, "10th_percentile": 1635.41, "90th_percentile": 1635.41, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3103.24, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 651.68, "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": 651.68, "10th_percentile": 651.68, "90th_percentile": 651.68, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1982.97, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1982.97, "10th_percentile": 1982.97, "90th_percentile": 1982.97, "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": 1334.39, "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": 1334.39, "10th_percentile": 1334.39, "90th_percentile": 1334.39, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2792.92, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2792.92, "10th_percentile": 2792.92, "90th_percentile": 2792.92, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "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": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "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": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "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": 3103.24, "10th_percentile": 3103.24, "90th_percentile": 3103.24, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 3.2X230MM WITHOUT STOP NONRADIOLUCENT 705232", "code_information": [ { "code": "SUP-331813", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 179.33, "maximum": 1080.29, "setting": "outpatient", "gross_charge": 1080.29, "discounted_cash": 756.2, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 295.03, "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": 295.03, "10th_percentile": 295.03, "90th_percentile": 295.03, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 295.03, "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": 295.03, "10th_percentile": 295.03, "90th_percentile": 295.03, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 228.91, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 228.91, "10th_percentile": 228.91, "90th_percentile": 228.91, "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 HMO", "standard_charge_dollar": 228.91, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 228.91, "10th_percentile": 228.91, "90th_percentile": 228.91, "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": 864.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 864.23, "10th_percentile": 864.23, "90th_percentile": 864.23, "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": 864.23, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 864.23, "10th_percentile": 864.23, "90th_percentile": 864.23, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1080.29, "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 $1,080.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "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 $1,080.29 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 BLUECHOICE OPTIONS", "standard_charge_dollar": 251.38, "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": 251.38, "10th_percentile": 251.38, "90th_percentile": 251.38, "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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 237.77, "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": 237.77, "10th_percentile": 237.77, "90th_percentile": 237.77, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 486.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 486.13, "10th_percentile": 486.13, "90th_percentile": 486.13, "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": 226.43, "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": 226.43, "10th_percentile": 226.43, "90th_percentile": 226.43, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 972.26, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 972.26, "10th_percentile": 972.26, "90th_percentile": 972.26, "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": 540.15, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 540.15, "10th_percentile": 540.15, "90th_percentile": 540.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 885.84, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 885.84, "10th_percentile": 885.84, "90th_percentile": 885.84, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 525.02, "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": 525.02, "10th_percentile": 525.02, "90th_percentile": 525.02, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1080.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 690.31, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 690.31, "10th_percentile": 690.31, "90th_percentile": 690.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1080.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 179.33, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 179.33, "10th_percentile": 179.33, "90th_percentile": 179.33, "count": "0", "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": 693.87, "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": 693.87, "10th_percentile": 693.87, "90th_percentile": 693.87, "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": 569.31, "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": 569.31, "10th_percentile": 569.31, "90th_percentile": 569.31, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 512.06, "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": 512.06, "10th_percentile": 512.06, "90th_percentile": 512.06, "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": 226.86, "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": 226.86, "10th_percentile": 226.86, "90th_percentile": 226.86, "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": 464.52, "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": 464.52, "10th_percentile": 464.52, "90th_percentile": 464.52, "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 ASA", "standard_charge_dollar": 491.53, "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": 491.53, "10th_percentile": 491.53, "90th_percentile": 491.53, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "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": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "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": 1080.29, "10th_percentile": 1080.29, "90th_percentile": 1080.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 35X1.6MM TWIST WITHOUT STOP NON RADIOLUCENT", "code_information": [ { "code": "SUP-378913", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 570.59, "maximum": 3437.29, "setting": "outpatient", "gross_charge": 3437.29, "discounted_cash": 2406.1, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 938.72, "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": 938.72, "10th_percentile": 938.72, "90th_percentile": 938.72, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 938.72, "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": 938.72, "10th_percentile": 938.72, "90th_percentile": 938.72, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 728.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 728.36, "10th_percentile": 728.36, "90th_percentile": 728.36, "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 HMO", "standard_charge_dollar": 728.36, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 728.36, "10th_percentile": 728.36, "90th_percentile": 728.36, "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": 2749.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2749.83, "10th_percentile": 2749.83, "90th_percentile": 2749.83, "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": 2749.83, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2749.83, "10th_percentile": 2749.83, "90th_percentile": 2749.83, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3437.29, "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 $3,437.29 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "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 $3,437.29 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 BLUECHOICE OPTIONS", "standard_charge_dollar": 799.86, "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": 799.86, "10th_percentile": 799.86, "90th_percentile": 799.86, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 756.55, "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": 756.55, "10th_percentile": 756.55, "90th_percentile": 756.55, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1546.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1546.78, "10th_percentile": 1546.78, "90th_percentile": 1546.78, "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": 720.46, "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": 720.46, "10th_percentile": 720.46, "90th_percentile": 720.46, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3093.56, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3093.56, "10th_percentile": 3093.56, "90th_percentile": 3093.56, "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": 1718.65, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1718.65, "10th_percentile": 1718.65, "90th_percentile": 1718.65, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2818.58, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2818.58, "10th_percentile": 2818.58, "90th_percentile": 2818.58, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1670.52, "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": 1670.52, "10th_percentile": 1670.52, "90th_percentile": 1670.52, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3437.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2196.43, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2196.43, "10th_percentile": 2196.43, "90th_percentile": 2196.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3437.29, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 570.59, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 570.59, "10th_percentile": 570.59, "90th_percentile": 570.59, "count": "0", "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": 2207.77, "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": 2207.77, "10th_percentile": 2207.77, "90th_percentile": 2207.77, "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": 1811.45, "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": 1811.45, "10th_percentile": 1811.45, "90th_percentile": 1811.45, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1629.28, "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": 1629.28, "10th_percentile": 1629.28, "90th_percentile": 1629.28, "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": 721.83, "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": 721.83, "10th_percentile": 721.83, "90th_percentile": 721.83, "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": 1478.03, "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": 1478.03, "10th_percentile": 1478.03, "90th_percentile": 1478.03, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1563.97, "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": 1563.97, "10th_percentile": 1563.97, "90th_percentile": 1563.97, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "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": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "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": 3437.29, "10th_percentile": 3437.29, "90th_percentile": 3437.29, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 4.5/6.5MM 485MM TI STEPPED RECON 03.010.078", "code_information": [ { "code": "SUP-344359", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1004.62, "maximum": 6051.94, "setting": "outpatient", "gross_charge": 6051.94, "discounted_cash": 4236.36, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4841.55, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4841.55, "10th_percentile": 4841.55, "90th_percentile": 4841.55, "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": 4841.55, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4841.55, "10th_percentile": 4841.55, "90th_percentile": 4841.55, "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": 1282.41, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1282.41, "10th_percentile": 1282.41, "90th_percentile": 1282.41, "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 HMO", "standard_charge_dollar": 1282.41, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1282.41, "10th_percentile": 1282.41, "90th_percentile": 1282.41, "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": 1652.78, "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": 1652.78, "10th_percentile": 1652.78, "90th_percentile": 1652.78, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1652.78, "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": 1652.78, "10th_percentile": 1652.78, "90th_percentile": 1652.78, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 6051.94, "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 $6,051.94 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "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 $6,051.94 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": 1332.03, "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": 1332.03, "10th_percentile": 1332.03, "90th_percentile": 1332.03, "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": 1268.49, "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": 1268.49, "10th_percentile": 1268.49, "90th_percentile": 1268.49, "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": 1408.29, "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": 1408.29, "10th_percentile": 1408.29, "90th_percentile": 1408.29, "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": 2723.37, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 2723.37, "10th_percentile": 2723.37, "90th_percentile": 2723.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3025.97, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3025.97, "10th_percentile": 3025.97, "90th_percentile": 3025.97, "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", "standard_charge_dollar": 2602.33, "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": 2602.33, "10th_percentile": 2602.33, "90th_percentile": 2602.33, "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": 1004.62, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1004.62, "10th_percentile": 1004.62, "90th_percentile": 1004.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 5446.75, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 5446.75, "10th_percentile": 5446.75, "90th_percentile": 5446.75, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 3867.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3867.19, "10th_percentile": 3867.19, "90th_percentile": 3867.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 4962.59, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 4962.59, "10th_percentile": 4962.59, "90th_percentile": 4962.59, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 2941.24, "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": 2941.24, "10th_percentile": 2941.24, "90th_percentile": 2941.24, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2868.62, "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": 2868.62, "10th_percentile": 2868.62, "90th_percentile": 2868.62, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 6051.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3887.16, "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": 3887.16, "10th_percentile": 3887.16, "90th_percentile": 3887.16, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 6051.94, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1270.91, "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": 1270.91, "10th_percentile": 1270.91, "90th_percentile": 1270.91, "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 ASA", "standard_charge_dollar": 2753.63, "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": 2753.63, "10th_percentile": 2753.63, "90th_percentile": 2753.63, "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": 3189.37, "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": 3189.37, "10th_percentile": 3189.37, "90th_percentile": 3189.37, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "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": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "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": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "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": 6051.94, "10th_percentile": 6051.94, "90th_percentile": 6051.94, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 5.5MM", "code_information": [ { "code": "SUP-162068", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 251.01, "maximum": 1512.12, "setting": "outpatient", "gross_charge": 1512.12, "discounted_cash": 1058.48, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 412.96, "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": 412.96, "10th_percentile": 412.96, "90th_percentile": 412.96, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 412.96, "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": 412.96, "10th_percentile": 412.96, "90th_percentile": 412.96, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 320.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 320.42, "10th_percentile": 320.42, "90th_percentile": 320.42, "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 HMO", "standard_charge_dollar": 320.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 320.42, "10th_percentile": 320.42, "90th_percentile": 320.42, "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": 1209.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1209.7, "10th_percentile": 1209.7, "90th_percentile": 1209.7, "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": 1209.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1209.7, "10th_percentile": 1209.7, "90th_percentile": 1209.7, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1512.12, "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 $1,512.12 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "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 $1,512.12 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": 351.87, "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": 351.87, "10th_percentile": 351.87, "90th_percentile": 351.87, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 332.82, "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": 332.82, "10th_percentile": 332.82, "90th_percentile": 332.82, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 680.45, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 680.45, "10th_percentile": 680.45, "90th_percentile": 680.45, "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": 316.94, "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": 316.94, "10th_percentile": 316.94, "90th_percentile": 316.94, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1360.91, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1360.91, "10th_percentile": 1360.91, "90th_percentile": 1360.91, "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": 756.06, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 756.06, "10th_percentile": 756.06, "90th_percentile": 756.06, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1239.94, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1239.94, "10th_percentile": 1239.94, "90th_percentile": 1239.94, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 734.89, "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": 734.89, "10th_percentile": 734.89, "90th_percentile": 734.89, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1512.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 966.24, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 966.24, "10th_percentile": 966.24, "90th_percentile": 966.24, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1512.12, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 251.01, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 251.01, "10th_percentile": 251.01, "90th_percentile": 251.01, "count": "0", "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": 971.23, "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": 971.23, "10th_percentile": 971.23, "90th_percentile": 971.23, "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": 796.89, "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": 796.89, "10th_percentile": 796.89, "90th_percentile": 796.89, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 716.74, "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": 716.74, "10th_percentile": 716.74, "90th_percentile": 716.74, "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": 317.55, "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": 317.55, "10th_percentile": 317.55, "90th_percentile": 317.55, "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": 650.21, "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": 650.21, "10th_percentile": 650.21, "90th_percentile": 650.21, "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 ASA", "standard_charge_dollar": 688.01, "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": 688.01, "10th_percentile": 688.01, "90th_percentile": 688.01, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "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": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "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": 1512.12, "10th_percentile": 1512.12, "90th_percentile": 1512.12, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL 9IN 9MM SS FLTD CLBRTD CNNLTD ARTHRSCPC BDGR", "code_information": [ { "code": "SUP-438047", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 67.18, "maximum": 404.69, "setting": "outpatient", "gross_charge": 404.69, "discounted_cash": 283.28, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 110.52, "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": 110.52, "10th_percentile": 110.52, "90th_percentile": 110.52, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 110.52, "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": 110.52, "10th_percentile": 110.52, "90th_percentile": 110.52, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 85.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "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 HMO", "standard_charge_dollar": 85.75, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 85.75, "10th_percentile": 85.75, "90th_percentile": 85.75, "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": 323.75, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 323.75, "10th_percentile": 323.75, "90th_percentile": 323.75, "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": 323.75, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 323.75, "10th_percentile": 323.75, "90th_percentile": 323.75, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 404.69, "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 $404.69 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "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 $404.69 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": 94.17, "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": 94.17, "10th_percentile": 94.17, "90th_percentile": 94.17, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 89.07, "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": 89.07, "10th_percentile": 89.07, "90th_percentile": 89.07, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 182.11, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 182.11, "10th_percentile": 182.11, "90th_percentile": 182.11, "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": 84.82, "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": 84.82, "10th_percentile": 84.82, "90th_percentile": 84.82, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 364.22, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 364.22, "10th_percentile": 364.22, "90th_percentile": 364.22, "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": 202.35, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 202.35, "10th_percentile": 202.35, "90th_percentile": 202.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 331.85, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 331.85, "10th_percentile": 331.85, "90th_percentile": 331.85, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 196.68, "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": 196.68, "10th_percentile": 196.68, "90th_percentile": 196.68, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 404.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 258.6, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 258.6, "10th_percentile": 258.6, "90th_percentile": 258.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 404.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 67.18, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 67.18, "10th_percentile": 67.18, "90th_percentile": 67.18, "count": "0", "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": 259.93, "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": 259.93, "10th_percentile": 259.93, "90th_percentile": 259.93, "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": 213.27, "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": 213.27, "10th_percentile": 213.27, "90th_percentile": 213.27, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 191.82, "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": 191.82, "10th_percentile": 191.82, "90th_percentile": 191.82, "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": 84.98, "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": 84.98, "10th_percentile": 84.98, "90th_percentile": 84.98, "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": 174.02, "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": 174.02, "10th_percentile": 174.02, "90th_percentile": 174.02, "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 ASA", "standard_charge_dollar": 184.13, "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": 184.13, "10th_percentile": 184.13, "90th_percentile": 184.13, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "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": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "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": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "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": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL OD1.7MM FLEXIBLE DISPOSABLE FIBERTAK AR-3600ND-3", "code_information": [ { "code": "SUP-416696", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 152.84, "maximum": 920.7, "setting": "outpatient", "gross_charge": 920.7, "discounted_cash": 644.49, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 736.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 736.56, "10th_percentile": 736.56, "90th_percentile": 736.56, "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": 736.56, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 736.56, "10th_percentile": 736.56, "90th_percentile": 736.56, "count": "0", "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": 251.44, "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": 251.44, "10th_percentile": 251.44, "90th_percentile": 251.44, "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 HMO", "standard_charge_dollar": 195.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 920.7, "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 $920.70 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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 $920.70 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": 202.65, "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": 202.65, "10th_percentile": 202.65, "90th_percentile": 202.65, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 414.32, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 414.32, "10th_percentile": 414.32, "90th_percentile": 414.32, "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 OPTIONS", "standard_charge_dollar": 214.25, "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": 214.25, "10th_percentile": 214.25, "90th_percentile": 214.25, "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 BLUECHOICE SELECT", "standard_charge_dollar": 192.98, "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": 192.98, "10th_percentile": 192.98, "90th_percentile": 192.98, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 591.37, "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": 591.37, "10th_percentile": 591.37, "90th_percentile": 591.37, "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 BROAD", "standard_charge_dollar": 447.46, "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": 447.46, "10th_percentile": 447.46, "90th_percentile": 447.46, "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": 754.97, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 754.97, "10th_percentile": 754.97, "90th_percentile": 754.97, "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": 460.35, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 460.35, "10th_percentile": 460.35, "90th_percentile": 460.35, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 920.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 436.41, "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": 436.41, "10th_percentile": 436.41, "90th_percentile": 436.41, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 485.21, "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": 485.21, "10th_percentile": 485.21, "90th_percentile": 485.21, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 920.7, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 193.35, "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": 193.35, "10th_percentile": 193.35, "90th_percentile": 193.35, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 588.33, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 588.33, "10th_percentile": 588.33, "90th_percentile": 588.33, "count": "0", "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": 828.63, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 828.63, "10th_percentile": 828.63, "90th_percentile": 828.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 195.1, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 195.1, "10th_percentile": 195.1, "90th_percentile": 195.1, "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": 251.44, "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": 251.44, "10th_percentile": 251.44, "90th_percentile": 251.44, "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", "standard_charge_dollar": 395.9, "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": 395.9, "10th_percentile": 395.9, "90th_percentile": 395.9, "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": 152.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 152.84, "10th_percentile": 152.84, "90th_percentile": 152.84, "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 ASA", "standard_charge_dollar": 418.92, "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": 418.92, "10th_percentile": 418.92, "90th_percentile": 418.92, "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": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "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": 920.7, "10th_percentile": 920.7, "90th_percentile": 920.7, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL QCK CPLING WO STOP NON-RDPQ 2.5MMX245MM", "code_information": [ { "code": "SUP-364492", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 167.32, "maximum": 1007.95, "setting": "outpatient", "gross_charge": 1007.95, "discounted_cash": 705.56, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 275.27, "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": 275.27, "10th_percentile": 275.27, "90th_percentile": 275.27, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 275.27, "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": 275.27, "10th_percentile": 275.27, "90th_percentile": 275.27, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 213.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 213.58, "10th_percentile": 213.58, "90th_percentile": 213.58, "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 HMO", "standard_charge_dollar": 213.58, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 213.58, "10th_percentile": 213.58, "90th_percentile": 213.58, "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": 806.36, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 806.36, "10th_percentile": 806.36, "90th_percentile": 806.36, "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": 806.36, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 806.36, "10th_percentile": 806.36, "90th_percentile": 806.36, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1007.95, "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 $1,007.95 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "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 $1,007.95 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 BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 234.55, "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": 234.55, "10th_percentile": 234.55, "90th_percentile": 234.55, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 221.85, "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": 221.85, "10th_percentile": 221.85, "90th_percentile": 221.85, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 453.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 453.58, "10th_percentile": 453.58, "90th_percentile": 453.58, "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": 211.27, "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": 211.27, "10th_percentile": 211.27, "90th_percentile": 211.27, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 907.16, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 907.16, "10th_percentile": 907.16, "90th_percentile": 907.16, "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": 503.98, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 503.98, "10th_percentile": 503.98, "90th_percentile": 503.98, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 826.52, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 826.52, "10th_percentile": 826.52, "90th_percentile": 826.52, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 489.86, "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": 489.86, "10th_percentile": 489.86, "90th_percentile": 489.86, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1007.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 644.08, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 644.08, "10th_percentile": 644.08, "90th_percentile": 644.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1007.95, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 167.32, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 167.32, "10th_percentile": 167.32, "90th_percentile": 167.32, "count": "0", "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": 647.41, "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": 647.41, "10th_percentile": 647.41, "90th_percentile": 647.41, "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": 531.19, "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": 531.19, "10th_percentile": 531.19, "90th_percentile": 531.19, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 477.77, "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": 477.77, "10th_percentile": 477.77, "90th_percentile": 477.77, "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": 211.67, "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": 211.67, "10th_percentile": 211.67, "90th_percentile": 211.67, "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": 433.42, "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": 433.42, "10th_percentile": 433.42, "90th_percentile": 433.42, "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 ASA", "standard_charge_dollar": 458.62, "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": 458.62, "10th_percentile": 458.62, "90th_percentile": 458.62, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "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": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "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": 1007.95, "10th_percentile": 1007.95, "90th_percentile": 1007.95, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL TWST 5MM X 1/8IN SS", "code_information": [ { "code": "SUP-333240", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 39.52, "maximum": 238.07, "setting": "outpatient", "gross_charge": 238.07, "discounted_cash": 166.65, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 65.02, "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": 65.02, "10th_percentile": 65.02, "90th_percentile": 65.02, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 65.02, "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": 65.02, "10th_percentile": 65.02, "90th_percentile": 65.02, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 50.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 50.45, "10th_percentile": 50.45, "90th_percentile": 50.45, "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 HMO", "standard_charge_dollar": 50.45, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 50.45, "10th_percentile": 50.45, "90th_percentile": 50.45, "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": 190.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 190.46, "10th_percentile": 190.46, "90th_percentile": 190.46, "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": 190.46, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 190.46, "10th_percentile": 190.46, "90th_percentile": 190.46, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 238.07, "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 $238.07 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "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 $238.07 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 OPTIONS", "standard_charge_dollar": 55.4, "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": 55.4, "10th_percentile": 55.4, "90th_percentile": 55.4, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 52.4, "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": 52.4, "10th_percentile": 52.4, "90th_percentile": 52.4, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 107.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 107.13, "10th_percentile": 107.13, "90th_percentile": 107.13, "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": 49.9, "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": 49.9, "10th_percentile": 49.9, "90th_percentile": 49.9, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 214.26, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 214.26, "10th_percentile": 214.26, "90th_percentile": 214.26, "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": 119.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 119.04, "10th_percentile": 119.04, "90th_percentile": 119.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 195.22, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 195.22, "10th_percentile": 195.22, "90th_percentile": 195.22, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 115.7, "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": 115.7, "10th_percentile": 115.7, "90th_percentile": 115.7, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 238.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 152.13, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 152.13, "10th_percentile": 152.13, "90th_percentile": 152.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 238.07, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 39.52, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 39.52, "10th_percentile": 39.52, "90th_percentile": 39.52, "count": "0", "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": 152.91, "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": 152.91, "10th_percentile": 152.91, "90th_percentile": 152.91, "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": 125.46, "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": 125.46, "10th_percentile": 125.46, "90th_percentile": 125.46, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 112.85, "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": 112.85, "10th_percentile": 112.85, "90th_percentile": 112.85, "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": 49.99, "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": 49.99, "10th_percentile": 49.99, "90th_percentile": 49.99, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 102.37, "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": 102.37, "10th_percentile": 102.37, "90th_percentile": 102.37, "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 ASA", "standard_charge_dollar": 108.32, "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": 108.32, "10th_percentile": 108.32, "90th_percentile": 108.32, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "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": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "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": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "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": 238.07, "10th_percentile": 238.07, "90th_percentile": 238.07, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRILL ZIM 5/64\"", "code_information": [ { "code": "SUP-309215", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 40.87, "maximum": 246.18, "setting": "outpatient", "gross_charge": 246.18, "discounted_cash": 172.33, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 196.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 196.94, "10th_percentile": 196.94, "90th_percentile": 196.94, "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": 196.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 196.94, "10th_percentile": 196.94, "90th_percentile": 196.94, "count": "0", "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": 67.23, "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": 67.23, "10th_percentile": 67.23, "90th_percentile": 67.23, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 67.23, "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": 67.23, "10th_percentile": 67.23, "90th_percentile": 67.23, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 52.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 52.17, "10th_percentile": 52.17, "90th_percentile": 52.17, "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 HMO", "standard_charge_dollar": 52.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 52.17, "10th_percentile": 52.17, "90th_percentile": 52.17, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 246.18, "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 $246.18 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "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 $246.18 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": 54.18, "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": 54.18, "10th_percentile": 54.18, "90th_percentile": 54.18, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 110.78, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 110.78, "10th_percentile": 110.78, "90th_percentile": 110.78, "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 OPTIONS", "standard_charge_dollar": 57.29, "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": 57.29, "10th_percentile": 57.29, "90th_percentile": 57.29, "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 BLUECHOICE SELECT", "standard_charge_dollar": 51.6, "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": 51.6, "10th_percentile": 51.6, "90th_percentile": 51.6, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 158.12, "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": 158.12, "10th_percentile": 158.12, "90th_percentile": 158.12, "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 BROAD", "standard_charge_dollar": 119.64, "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": 119.64, "10th_percentile": 119.64, "90th_percentile": 119.64, "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": 201.87, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 201.87, "10th_percentile": 201.87, "90th_percentile": 201.87, "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": 123.09, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 123.09, "10th_percentile": 123.09, "90th_percentile": 123.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 246.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 40.87, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 40.87, "10th_percentile": 40.87, "90th_percentile": 40.87, "count": "0", "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": 116.69, "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": 116.69, "10th_percentile": 116.69, "90th_percentile": 116.69, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 112.01, "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": 112.01, "10th_percentile": 112.01, "90th_percentile": 112.01, "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": 129.74, "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": 129.74, "10th_percentile": 129.74, "90th_percentile": 129.74, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 246.18, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 51.7, "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": 51.7, "10th_percentile": 51.7, "90th_percentile": 51.7, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 157.31, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 157.31, "10th_percentile": 157.31, "90th_percentile": 157.31, "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": 105.86, "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": 105.86, "10th_percentile": 105.86, "90th_percentile": 105.86, "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": 221.56, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 221.56, "10th_percentile": 221.56, "90th_percentile": 221.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "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": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "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": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "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": 246.18, "10th_percentile": 246.18, "90th_percentile": 246.18, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRLL 135X45MM QC CLBRTN STRL", "code_information": [ { "code": "SUP-432981", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 221.71, "maximum": 1335.63, "setting": "outpatient", "gross_charge": 1335.63, "discounted_cash": 934.94, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1068.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1068.5, "10th_percentile": 1068.5, "90th_percentile": 1068.5, "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": 1068.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1068.5, "10th_percentile": 1068.5, "90th_percentile": 1068.5, "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 HMO", "standard_charge_dollar": 283.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 283.02, "10th_percentile": 283.02, "90th_percentile": 283.02, "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 HMO", "standard_charge_dollar": 283.02, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 283.02, "10th_percentile": 283.02, "90th_percentile": 283.02, "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": 364.76, "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": 364.76, "10th_percentile": 364.76, "90th_percentile": 364.76, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 364.76, "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": 364.76, "10th_percentile": 364.76, "90th_percentile": 364.76, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1335.63, "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 $1,335.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "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 $1,335.63 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": 293.97, "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": 293.97, "10th_percentile": 293.97, "90th_percentile": 293.97, "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": 279.95, "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": 279.95, "10th_percentile": 279.95, "90th_percentile": 279.95, "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": 310.8, "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": 310.8, "10th_percentile": 310.8, "90th_percentile": 310.8, "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": 601.03, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 601.03, "10th_percentile": 601.03, "90th_percentile": 601.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 667.82, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 667.82, "10th_percentile": 667.82, "90th_percentile": 667.82, "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", "standard_charge_dollar": 574.32, "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": 574.32, "10th_percentile": 574.32, "90th_percentile": 574.32, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 221.71, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 221.71, "10th_percentile": 221.71, "90th_percentile": 221.71, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1202.07, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1202.07, "10th_percentile": 1202.07, "90th_percentile": 1202.07, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 853.47, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 853.47, "10th_percentile": 853.47, "90th_percentile": 853.47, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1095.22, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1095.22, "10th_percentile": 1095.22, "90th_percentile": 1095.22, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 649.12, "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": 649.12, "10th_percentile": 649.12, "90th_percentile": 649.12, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 633.09, "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": 633.09, "10th_percentile": 633.09, "90th_percentile": 633.09, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1335.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 857.88, "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": 857.88, "10th_percentile": 857.88, "90th_percentile": 857.88, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1335.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 280.48, "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": 280.48, "10th_percentile": 280.48, "90th_percentile": 280.48, "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 ASA", "standard_charge_dollar": 607.71, "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": 607.71, "10th_percentile": 607.71, "90th_percentile": 607.71, "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": 703.88, "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": 703.88, "10th_percentile": 703.88, "90th_percentile": 703.88, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "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": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "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": 1335.63, "10th_percentile": 1335.63, "90th_percentile": 1335.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRLL 195X6MM CNNLTD QCK CPLNG ADJSTBL STP RSBL", "code_information": [ { "code": "SUP-438947", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 317.03, "maximum": 1909.8, "setting": "outpatient", "gross_charge": 1909.8, "discounted_cash": 1336.86, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1527.84, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1527.84, "10th_percentile": 1527.84, "90th_percentile": 1527.84, "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": 1527.84, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1527.84, "10th_percentile": 1527.84, "90th_percentile": 1527.84, "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": 404.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "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 HMO", "standard_charge_dollar": 404.69, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 404.69, "10th_percentile": 404.69, "90th_percentile": 404.69, "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": 521.57, "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": 521.57, "10th_percentile": 521.57, "90th_percentile": 521.57, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 521.57, "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": 521.57, "10th_percentile": 521.57, "90th_percentile": 521.57, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1909.8, "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 $1,909.80 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "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 $1,909.80 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": 420.35, "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": 420.35, "10th_percentile": 420.35, "90th_percentile": 420.35, "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": 400.29, "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": 400.29, "10th_percentile": 400.29, "90th_percentile": 400.29, "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": 444.41, "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": 444.41, "10th_percentile": 444.41, "90th_percentile": 444.41, "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": 859.41, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 859.41, "10th_percentile": 859.41, "90th_percentile": 859.41, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 954.9, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 954.9, "10th_percentile": 954.9, "90th_percentile": 954.9, "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", "standard_charge_dollar": 821.21, "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": 821.21, "10th_percentile": 821.21, "90th_percentile": 821.21, "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": 317.03, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 317.03, "10th_percentile": 317.03, "90th_percentile": 317.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1718.82, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1718.82, "10th_percentile": 1718.82, "90th_percentile": 1718.82, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1220.36, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1220.36, "10th_percentile": 1220.36, "90th_percentile": 1220.36, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1566.04, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1566.04, "10th_percentile": 1566.04, "90th_percentile": 1566.04, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 928.16, "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": 928.16, "10th_percentile": 928.16, "90th_percentile": 928.16, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 905.25, "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": 905.25, "10th_percentile": 905.25, "90th_percentile": 905.25, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1909.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1226.66, "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": 1226.66, "10th_percentile": 1226.66, "90th_percentile": 1226.66, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1909.8, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 401.06, "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": 401.06, "10th_percentile": 401.06, "90th_percentile": 401.06, "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 ASA", "standard_charge_dollar": 868.96, "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": 868.96, "10th_percentile": 868.96, "90th_percentile": 868.96, "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": 1006.46, "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": 1006.46, "10th_percentile": 1006.46, "90th_percentile": 1006.46, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "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": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "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": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "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": 1909.8, "10th_percentile": 1909.8, "90th_percentile": 1909.8, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRLL 2.5X110MM AO QCK CNNCT", "code_information": [ { "code": "SUP-434563", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 104.8, "maximum": 631.34, "setting": "outpatient", "gross_charge": 631.34, "discounted_cash": 441.94, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 172.42, "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": 172.42, "10th_percentile": 172.42, "90th_percentile": 172.42, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 172.42, "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": 172.42, "10th_percentile": 172.42, "90th_percentile": 172.42, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 133.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 133.78, "10th_percentile": 133.78, "90th_percentile": 133.78, "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 HMO", "standard_charge_dollar": 133.78, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 133.78, "10th_percentile": 133.78, "90th_percentile": 133.78, "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": 505.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 505.07, "10th_percentile": 505.07, "90th_percentile": 505.07, "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": 505.07, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 505.07, "10th_percentile": 505.07, "90th_percentile": 505.07, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 631.34, "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 $631.34 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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 $631.34 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": 146.91, "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": 146.91, "10th_percentile": 146.91, "90th_percentile": 146.91, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 138.96, "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": 138.96, "10th_percentile": 138.96, "90th_percentile": 138.96, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 284.1, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 284.1, "10th_percentile": 284.1, "90th_percentile": 284.1, "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": 132.33, "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": 132.33, "10th_percentile": 132.33, "90th_percentile": 132.33, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 568.21, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 568.21, "10th_percentile": 568.21, "90th_percentile": 568.21, "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": 315.67, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 315.67, "10th_percentile": 315.67, "90th_percentile": 315.67, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 517.7, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 517.7, "10th_percentile": 517.7, "90th_percentile": 517.7, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 306.83, "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": 306.83, "10th_percentile": 306.83, "90th_percentile": 306.83, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 631.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 403.43, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 403.43, "10th_percentile": 403.43, "90th_percentile": 403.43, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 631.34, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 104.8, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 104.8, "10th_percentile": 104.8, "90th_percentile": 104.8, "count": "0", "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": 405.51, "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": 405.51, "10th_percentile": 405.51, "90th_percentile": 405.51, "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": 332.72, "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": 332.72, "10th_percentile": 332.72, "90th_percentile": 332.72, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 299.26, "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": 299.26, "10th_percentile": 299.26, "90th_percentile": 299.26, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 132.58, "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": 132.58, "10th_percentile": 132.58, "90th_percentile": 132.58, "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": 271.48, "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": 271.48, "10th_percentile": 271.48, "90th_percentile": 271.48, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 287.26, "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": 287.26, "10th_percentile": 287.26, "90th_percentile": 287.26, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRLL 215X5MM CNNLTD LG QCK CPLNG STRL", "code_information": [ { "code": "SUP-433849", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 707.84, "maximum": 4264.08, "setting": "outpatient", "gross_charge": 4264.08, "discounted_cash": 2984.86, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1164.52, "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": 1164.52, "10th_percentile": 1164.52, "90th_percentile": 1164.52, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1164.52, "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": 1164.52, "10th_percentile": 1164.52, "90th_percentile": 1164.52, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 903.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 903.56, "10th_percentile": 903.56, "90th_percentile": 903.56, "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 HMO", "standard_charge_dollar": 903.56, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 903.56, "10th_percentile": 903.56, "90th_percentile": 903.56, "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": 3411.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3411.26, "10th_percentile": 3411.26, "90th_percentile": 3411.26, "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": 3411.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3411.26, "10th_percentile": 3411.26, "90th_percentile": 3411.26, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 4264.08, "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 $4,264.08 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "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 $4,264.08 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 BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 992.25, "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": 992.25, "10th_percentile": 992.25, "90th_percentile": 992.25, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 938.52, "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": 938.52, "10th_percentile": 938.52, "90th_percentile": 938.52, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1918.84, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1918.84, "10th_percentile": 1918.84, "90th_percentile": 1918.84, "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 BLUECHOICE SELECT", "standard_charge_dollar": 893.75, "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": 893.75, "10th_percentile": 893.75, "90th_percentile": 893.75, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3837.67, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3837.67, "10th_percentile": 3837.67, "90th_percentile": 3837.67, "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": 2132.04, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2132.04, "10th_percentile": 2132.04, "90th_percentile": 2132.04, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3496.55, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 3496.55, "10th_percentile": 3496.55, "90th_percentile": 3496.55, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 2072.34, "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": 2072.34, "10th_percentile": 2072.34, "90th_percentile": 2072.34, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4264.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2724.75, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2724.75, "10th_percentile": 2724.75, "90th_percentile": 2724.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4264.08, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 707.84, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 707.84, "10th_percentile": 707.84, "90th_percentile": 707.84, "count": "0", "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": 2738.82, "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": 2738.82, "10th_percentile": 2738.82, "90th_percentile": 2738.82, "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": 2247.17, "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": 2247.17, "10th_percentile": 2247.17, "90th_percentile": 2247.17, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2021.17, "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": 2021.17, "10th_percentile": 2021.17, "90th_percentile": 2021.17, "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": 895.46, "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": 895.46, "10th_percentile": 895.46, "90th_percentile": 895.46, "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": 1833.55, "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": 1833.55, "10th_percentile": 1833.55, "90th_percentile": 1833.55, "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 ASA", "standard_charge_dollar": 1940.16, "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": 1940.16, "10th_percentile": 1940.16, "90th_percentile": 1940.16, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "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": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "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": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "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": 4264.08, "10th_percentile": 4264.08, "90th_percentile": 4264.08, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIT DRLL SPNL 12MM CNTNM", "code_information": [ { "code": "SUP-438542", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 131.0, "maximum": 789.17, "setting": "outpatient", "gross_charge": 789.17, "discounted_cash": 552.42, "payers_information": [ { "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": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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": 631.34, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 631.34, "10th_percentile": 631.34, "90th_percentile": 631.34, "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": 167.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 167.23, "10th_percentile": 167.23, "90th_percentile": 167.23, "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 HMO", "standard_charge_dollar": 167.23, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 167.23, "10th_percentile": 167.23, "90th_percentile": 167.23, "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": 215.52, "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": 215.52, "10th_percentile": 215.52, "90th_percentile": 215.52, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 215.52, "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": 215.52, "10th_percentile": 215.52, "90th_percentile": 215.52, "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 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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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 $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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 173.7, "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": 173.7, "10th_percentile": 173.7, "90th_percentile": 173.7, "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": 165.41, "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": 165.41, "10th_percentile": 165.41, "90th_percentile": 165.41, "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": 183.64, "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": 183.64, "10th_percentile": 183.64, "90th_percentile": 183.64, "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": 355.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 355.13, "10th_percentile": 355.13, "90th_percentile": 355.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% 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": 394.59, "10th_percentile": 394.59, "90th_percentile": 394.59, "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", "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": 339.34, "10th_percentile": 339.34, "90th_percentile": 339.34, "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": 131.0, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 131.0, "10th_percentile": 131.0, "90th_percentile": 131.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "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": 710.25, "10th_percentile": 710.25, "90th_percentile": 710.25, "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": "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": 504.28, "10th_percentile": 504.28, "90th_percentile": 504.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 647.12, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 647.12, "10th_percentile": 647.12, "90th_percentile": 647.12, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 383.54, "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": 383.54, "10th_percentile": 383.54, "90th_percentile": 383.54, "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": "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": 374.07, "10th_percentile": 374.07, "90th_percentile": 374.07, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 789.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "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": 506.88, "10th_percentile": 506.88, "90th_percentile": 506.88, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 789.17, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 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": "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": 165.73, "10th_percentile": 165.73, "90th_percentile": 165.73, "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 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": 359.07, "10th_percentile": 359.07, "90th_percentile": 359.07, "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": 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": 415.89, "10th_percentile": 415.89, "90th_percentile": 415.89, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BIVALIRUDIN 250 MG IV SOLR", "drug_information": { "unit": 1.0, "type": "UN" }, "code_information": [ { "code": "RX-29396", "type": "CDM" }, { "code": "J0583", "type": "HCPCS" }, { "code": "0636", "type": "RC" }, { "code": "63323-0562-10", "type": "NDC" } ], "standard_charges": [ { "minimum": 44.2, "maximum": 266.25, "setting": "outpatient", "gross_charge": 266.25, "discounted_cash": 186.37, "payers_information": [ { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 218.33, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "All Other OP - Single Episode; 82% Billed, and; Pricing Extension - NM HB XR PRC - NTE $19,355 CASE RATE", "median_amount": 218.33, "10th_percentile": 218.33, "90th_percentile": 218.33, "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 $19,355 CASE RATE" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 119.81, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 119.81, "10th_percentile": 119.81, "90th_percentile": 119.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 170.13, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 170.13, "10th_percentile": 170.13, "90th_percentile": 170.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 133.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 133.13, "10th_percentile": 133.13, "90th_percentile": 133.13, "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": 239.63, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 239.63, "10th_percentile": 239.63, "90th_percentile": 239.63, "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 NM EMPLOYEES", "standard_charge_dollar": 44.2, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 44.2, "10th_percentile": 44.2, "90th_percentile": 44.2, "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 ASA", "standard_charge_dollar": 121.14, "standard_charge_percentage": 45.5, "standard_charge_algorithm": "Drugs/Agents; 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": 121.14, "10th_percentile": 121.14, "90th_percentile": 121.14, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Drugs/Agents; 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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 266.25, "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 $266.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other OP. ADP RATE (for patient estimates only); 100% Billed, and; Pricing Extension - HB XR PRC - Lesser Of Terms Or Total Billed Amount; Note: Paid $266.25 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 266.25, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 72.69, "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": 72.69, "10th_percentile": 72.69, "90th_percentile": 72.69, "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": 72.69, "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": 72.69, "10th_percentile": 72.69, "90th_percentile": 72.69, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 213.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 213.0, "10th_percentile": 213.0, "90th_percentile": 213.0, "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": 213.0, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 213.0, "10th_percentile": 213.0, "90th_percentile": 213.0, "count": "0", "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": 56.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 56.42, "10th_percentile": 56.42, "90th_percentile": 56.42, "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": 56.42, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 56.42, "10th_percentile": 56.42, "90th_percentile": 56.42, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 62.3, "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": 62.3, "10th_percentile": 62.3, "90th_percentile": 62.3, "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 SELECT", "standard_charge_dollar": 62.3, "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": 62.3, "10th_percentile": 62.3, "90th_percentile": 62.3, "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": 62.3, "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": 62.3, "10th_percentile": 62.3, "90th_percentile": 62.3, "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": "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: $266.25 @ 12.8% = $34.08 due to $0.00 Claim Price", "median_amount": 34.08, "10th_percentile": 34.08, "90th_percentile": 34.08, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $266.25 @ 12.8% = $34.08 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": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 266.25, "10th_percentile": 266.25, "90th_percentile": 266.25, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE BEAVER 75L (37-7515)", "code_information": [ { "code": "SUP-156803", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 10.96, "maximum": 66.03, "setting": "outpatient", "gross_charge": 66.03, "discounted_cash": 46.22, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 18.03, "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": 18.03, "10th_percentile": 18.03, "90th_percentile": 18.03, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 18.03, "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": 18.03, "10th_percentile": 18.03, "90th_percentile": 18.03, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 13.99, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 13.99, "10th_percentile": 13.99, "90th_percentile": 13.99, "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 HMO", "standard_charge_dollar": 13.99, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 13.99, "10th_percentile": 13.99, "90th_percentile": 13.99, "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": 52.82, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 52.82, "10th_percentile": 52.82, "90th_percentile": 52.82, "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": 52.82, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 52.82, "10th_percentile": 52.82, "90th_percentile": 52.82, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 66.03, "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 $66.03 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "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 $66.03 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 OPTIONS", "standard_charge_dollar": 15.37, "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": 15.37, "10th_percentile": 15.37, "90th_percentile": 15.37, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 14.53, "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": 14.53, "10th_percentile": 14.53, "90th_percentile": 14.53, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 29.71, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 29.71, "10th_percentile": 29.71, "90th_percentile": 29.71, "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": 13.84, "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": 13.84, "10th_percentile": 13.84, "90th_percentile": 13.84, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 59.43, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 59.43, "10th_percentile": 59.43, "90th_percentile": 59.43, "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": 33.02, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 33.02, "10th_percentile": 33.02, "90th_percentile": 33.02, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 54.14, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 54.14, "10th_percentile": 54.14, "90th_percentile": 54.14, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 32.09, "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": 32.09, "10th_percentile": 32.09, "90th_percentile": 32.09, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 66.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 42.19, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 42.19, "10th_percentile": 42.19, "90th_percentile": 42.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 66.03, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 10.96, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 10.96, "10th_percentile": 10.96, "90th_percentile": 10.96, "count": "0", "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": 42.41, "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": 42.41, "10th_percentile": 42.41, "90th_percentile": 42.41, "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": 34.8, "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": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 31.3, "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": 31.3, "10th_percentile": 31.3, "90th_percentile": 31.3, "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": 13.87, "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": 13.87, "10th_percentile": 13.87, "90th_percentile": 13.87, "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": 28.39, "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": 28.39, "10th_percentile": 28.39, "90th_percentile": 28.39, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 30.04, "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": 30.04, "10th_percentile": 30.04, "90th_percentile": 30.04, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "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": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "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": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "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": 66.03, "10th_percentile": 66.03, "90th_percentile": 66.03, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE CRVD 12MMX16CM LATERAL HIP SBLDCURVE-2", "code_information": [ { "code": "SUP-423529", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 551.93, "maximum": 3324.88, "setting": "outpatient", "gross_charge": 3324.88, "discounted_cash": 2327.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 908.02, "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": 908.02, "10th_percentile": 908.02, "90th_percentile": 908.02, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 908.02, "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": 908.02, "10th_percentile": 908.02, "90th_percentile": 908.02, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 704.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 704.54, "10th_percentile": 704.54, "90th_percentile": 704.54, "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 HMO", "standard_charge_dollar": 704.54, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 704.54, "10th_percentile": 704.54, "90th_percentile": 704.54, "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": 2659.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2659.9, "10th_percentile": 2659.9, "90th_percentile": 2659.9, "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": 2659.9, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 2659.9, "10th_percentile": 2659.9, "90th_percentile": 2659.9, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 3324.88, "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 $3,324.88 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "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 $3,324.88 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": 773.7, "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": 773.7, "10th_percentile": 773.7, "90th_percentile": 773.7, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 731.81, "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": 731.81, "10th_percentile": 731.81, "90th_percentile": 731.81, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1496.2, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1496.2, "10th_percentile": 1496.2, "90th_percentile": 1496.2, "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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 696.89, "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": 696.89, "10th_percentile": 696.89, "90th_percentile": 696.89, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 2992.39, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 2992.39, "10th_percentile": 2992.39, "90th_percentile": 2992.39, "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": 1662.44, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 1662.44, "10th_percentile": 1662.44, "90th_percentile": 1662.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 2726.4, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 2726.4, "10th_percentile": 2726.4, "90th_percentile": 2726.4, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 1615.89, "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": 1615.89, "10th_percentile": 1615.89, "90th_percentile": 1615.89, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 3324.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2124.6, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2124.6, "10th_percentile": 2124.6, "90th_percentile": 2124.6, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 3324.88, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 551.93, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 551.93, "10th_percentile": 551.93, "90th_percentile": 551.93, "count": "0", "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": 2135.57, "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": 2135.57, "10th_percentile": 2135.57, "90th_percentile": 2135.57, "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": 1752.21, "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": 1752.21, "10th_percentile": 1752.21, "90th_percentile": 1752.21, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1575.99, "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": 1575.99, "10th_percentile": 1575.99, "90th_percentile": 1575.99, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 698.22, "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": 698.22, "10th_percentile": 698.22, "90th_percentile": 698.22, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1429.7, "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": 1429.7, "10th_percentile": 1429.7, "90th_percentile": 1429.7, "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 ASA", "standard_charge_dollar": 1512.82, "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": 1512.82, "10th_percentile": 1512.82, "90th_percentile": 1512.82, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "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": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "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": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "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": 3324.88, "10th_percentile": 3324.88, "90th_percentile": 3324.88, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE CUPPED 6MMX3CM SNGL USE", "code_information": [ { "code": "SUP-422444", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1746.71, "maximum": 10522.32, "setting": "outpatient", "gross_charge": 10522.32, "discounted_cash": 7365.62, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 8417.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8417.86, "10th_percentile": 8417.86, "90th_percentile": 8417.86, "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": 8417.86, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 8417.86, "10th_percentile": 8417.86, "90th_percentile": 8417.86, "count": "0", "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": 2873.65, "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": 2873.65, "10th_percentile": 2873.65, "90th_percentile": 2873.65, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2873.65, "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": 2873.65, "10th_percentile": 2873.65, "90th_percentile": 2873.65, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 2229.68, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2229.68, "10th_percentile": 2229.68, "90th_percentile": 2229.68, "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 HMO", "standard_charge_dollar": 2229.68, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 2229.68, "10th_percentile": 2229.68, "90th_percentile": 2229.68, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 10522.32, "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 $10,522.32 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "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 $10,522.32 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 2315.96, "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": 2315.96, "10th_percentile": 2315.96, "90th_percentile": 2315.96, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4735.04, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 4735.04, "10th_percentile": 4735.04, "90th_percentile": 4735.04, "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 OPTIONS", "standard_charge_dollar": 2448.54, "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": 2448.54, "10th_percentile": 2448.54, "90th_percentile": 2448.54, "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 BLUECHOICE SELECT", "standard_charge_dollar": 2205.48, "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": 2205.48, "10th_percentile": 2205.48, "90th_percentile": 2205.48, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 6758.49, "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": 6758.49, "10th_percentile": 6758.49, "90th_percentile": 6758.49, "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 BROAD", "standard_charge_dollar": 5113.85, "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": 5113.85, "10th_percentile": 5113.85, "90th_percentile": 5113.85, "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": 8628.3, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 8628.3, "10th_percentile": 8628.3, "90th_percentile": 8628.3, "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": 5261.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 5261.16, "10th_percentile": 5261.16, "90th_percentile": 5261.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 10522.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1746.71, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1746.71, "10th_percentile": 1746.71, "90th_percentile": 1746.71, "count": "0", "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": 4987.58, "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": 4987.58, "10th_percentile": 4987.58, "90th_percentile": 4987.58, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 4787.66, "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": 4787.66, "10th_percentile": 4787.66, "90th_percentile": 4787.66, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 5545.26, "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": 5545.26, "10th_percentile": 5545.26, "90th_percentile": 5545.26, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 10522.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 2209.69, "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": 2209.69, "10th_percentile": 2209.69, "90th_percentile": 2209.69, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 6723.76, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 6723.76, "10th_percentile": 6723.76, "90th_percentile": 6723.76, "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": 4524.6, "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": 4524.6, "10th_percentile": 4524.6, "90th_percentile": 4524.6, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 9470.09, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 9470.09, "10th_percentile": 9470.09, "90th_percentile": 9470.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "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": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "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": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "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": 10522.32, "10th_percentile": 10522.32, "90th_percentile": 10522.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE ENDO SOFT TISSUE FASCIA AR-8856DS", "code_information": [ { "code": "SUP-345393", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 1302.75, "maximum": 7847.9, "setting": "outpatient", "gross_charge": 7847.9, "discounted_cash": 5493.53, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 6278.32, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6278.32, "10th_percentile": 6278.32, "90th_percentile": 6278.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 5040.71, "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": 5040.71, "10th_percentile": 5040.71, "90th_percentile": 5040.71, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 7847.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 3719.9, "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": 3719.9, "10th_percentile": 3719.9, "90th_percentile": 3719.9, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 4135.84, "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": 4135.84, "10th_percentile": 4135.84, "90th_percentile": 4135.84, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 7847.9, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "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": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "count": "0", "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": 6278.32, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 6278.32, "10th_percentile": 6278.32, "90th_percentile": 6278.32, "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": 1662.97, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1662.97, "10th_percentile": 1662.97, "90th_percentile": 1662.97, "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 HMO", "standard_charge_dollar": 1662.97, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1662.97, "10th_percentile": 1662.97, "90th_percentile": 1662.97, "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": 2143.26, "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": 2143.26, "10th_percentile": 2143.26, "90th_percentile": 2143.26, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 2143.26, "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": 2143.26, "10th_percentile": 2143.26, "90th_percentile": 2143.26, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 7847.9, "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 $7,847.90 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "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 $7,847.90 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": 1727.32, "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": 1727.32, "10th_percentile": 1727.32, "90th_percentile": 1727.32, "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 SELECT", "standard_charge_dollar": 1644.92, "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": 1644.92, "10th_percentile": 1644.92, "90th_percentile": 1644.92, "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": 1826.21, "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": 1826.21, "10th_percentile": 1826.21, "90th_percentile": 1826.21, "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": 3531.56, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 3531.56, "10th_percentile": 3531.56, "90th_percentile": 3531.56, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 3923.95, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 3923.95, "10th_percentile": 3923.95, "90th_percentile": 3923.95, "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", "standard_charge_dollar": 3374.6, "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": 3374.6, "10th_percentile": 3374.6, "90th_percentile": 3374.6, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 1302.75, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 1302.75, "10th_percentile": 1302.75, "90th_percentile": 1302.75, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 7063.11, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 7063.11, "10th_percentile": 7063.11, "90th_percentile": 7063.11, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 5014.81, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 5014.81, "10th_percentile": 5014.81, "90th_percentile": 5014.81, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 6435.28, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 6435.28, "10th_percentile": 6435.28, "90th_percentile": 6435.28, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 3814.08, "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": 3814.08, "10th_percentile": 3814.08, "90th_percentile": 3814.08, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 1648.06, "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": 1648.06, "10th_percentile": 1648.06, "90th_percentile": 1648.06, "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 ASA", "standard_charge_dollar": 3570.79, "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": 3570.79, "10th_percentile": 3570.79, "90th_percentile": 3570.79, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "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": 7847.9, "10th_percentile": 7847.9, "90th_percentile": 7847.9, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE ENDSCPC HP CRVD", "code_information": [ { "code": "SUP-435731", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 246.08, "maximum": 1482.42, "setting": "outpatient", "gross_charge": 1482.42, "discounted_cash": 1037.69, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1185.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1185.94, "10th_percentile": 1185.94, "90th_percentile": 1185.94, "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": 1185.94, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1185.94, "10th_percentile": 1185.94, "90th_percentile": 1185.94, "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": 314.12, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 314.12, "10th_percentile": 314.12, "90th_percentile": 314.12, "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 HMO", "standard_charge_dollar": 314.12, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 314.12, "10th_percentile": 314.12, "90th_percentile": 314.12, "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": 404.85, "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": 404.85, "10th_percentile": 404.85, "90th_percentile": 404.85, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 404.85, "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": 404.85, "10th_percentile": 404.85, "90th_percentile": 404.85, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1482.42, "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 $1,482.42 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "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 $1,482.42 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 326.28, "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": 326.28, "10th_percentile": 326.28, "90th_percentile": 326.28, "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": 310.72, "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": 310.72, "10th_percentile": 310.72, "90th_percentile": 310.72, "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 BLUECHOICE OPTIONS", "standard_charge_dollar": 344.96, "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": 344.96, "10th_percentile": 344.96, "90th_percentile": 344.96, "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": 667.09, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 667.09, "10th_percentile": 667.09, "90th_percentile": 667.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 741.21, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 741.21, "10th_percentile": 741.21, "90th_percentile": 741.21, "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", "standard_charge_dollar": 637.44, "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": 637.44, "10th_percentile": 637.44, "90th_percentile": 637.44, "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": 246.08, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 246.08, "10th_percentile": 246.08, "90th_percentile": 246.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1334.18, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1334.18, "10th_percentile": 1334.18, "90th_percentile": 1334.18, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 947.27, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 947.27, "10th_percentile": 947.27, "90th_percentile": 947.27, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1215.58, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1215.58, "10th_percentile": 1215.58, "90th_percentile": 1215.58, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 720.46, "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": 720.46, "10th_percentile": 720.46, "90th_percentile": 720.46, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 702.67, "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": 702.67, "10th_percentile": 702.67, "90th_percentile": 702.67, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1482.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 952.16, "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": 952.16, "10th_percentile": 952.16, "90th_percentile": 952.16, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1482.42, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 311.31, "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": 311.31, "10th_percentile": 311.31, "90th_percentile": 311.31, "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 ASA", "standard_charge_dollar": 674.5, "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": 674.5, "10th_percentile": 674.5, "90th_percentile": 674.5, "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": 781.24, "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": 781.24, "10th_percentile": 781.24, "90th_percentile": 781.24, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "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": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "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": 1482.42, "10th_percentile": 1482.42, "90th_percentile": 1482.42, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE FIN STRAIGHT SINGLE USE", "code_information": [ { "code": "SUP-421822", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 269.28, "maximum": 1622.19, "setting": "outpatient", "gross_charge": 1622.19, "discounted_cash": 1135.53, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1297.75, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "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": 1297.75, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1297.75, "10th_percentile": 1297.75, "90th_percentile": 1297.75, "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": 343.74, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 343.74, "10th_percentile": 343.74, "90th_percentile": 343.74, "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 HMO", "standard_charge_dollar": 343.74, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 343.74, "10th_percentile": 343.74, "90th_percentile": 343.74, "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": 443.02, "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": 443.02, "10th_percentile": 443.02, "90th_percentile": 443.02, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 443.02, "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": 443.02, "10th_percentile": 443.02, "90th_percentile": 443.02, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1622.19, "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 $1,622.19 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "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 $1,622.19 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": 357.04, "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": 357.04, "10th_percentile": 357.04, "90th_percentile": 357.04, "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": 340.01, "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": 340.01, "10th_percentile": 340.01, "90th_percentile": 340.01, "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": 377.48, "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": 377.48, "10th_percentile": 377.48, "90th_percentile": 377.48, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 729.99, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 729.99, "10th_percentile": 729.99, "90th_percentile": 729.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 811.1, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 811.1, "10th_percentile": 811.1, "90th_percentile": 811.1, "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", "standard_charge_dollar": 697.54, "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": 697.54, "10th_percentile": 697.54, "90th_percentile": 697.54, "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": 269.28, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 269.28, "10th_percentile": 269.28, "90th_percentile": 269.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1459.97, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1459.97, "10th_percentile": 1459.97, "90th_percentile": 1459.97, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1036.58, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1036.58, "10th_percentile": 1036.58, "90th_percentile": 1036.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1330.2, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1330.2, "10th_percentile": 1330.2, "90th_percentile": 1330.2, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 788.38, "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": 788.38, "10th_percentile": 788.38, "90th_percentile": 788.38, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1622.19, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1041.93, "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": 1041.93, "10th_percentile": 1041.93, "90th_percentile": 1041.93, "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": 340.66, "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": 340.66, "10th_percentile": 340.66, "90th_percentile": 340.66, "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 ASA", "standard_charge_dollar": 738.1, "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": 738.1, "10th_percentile": 738.1, "90th_percentile": 738.1, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "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": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "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": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "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": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 768.92, "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": 768.92, "10th_percentile": 768.92, "90th_percentile": 768.92, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 854.89, "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": 854.89, "10th_percentile": 854.89, "90th_percentile": 854.89, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1622.19, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1622.19, "10th_percentile": 1622.19, "90th_percentile": 1622.19, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" } ] } ] }, { "description": "BLADE GLIDESCOPE TITANIUM SPECTRUM LOPRO S3 0270-0938", "code_information": [ { "code": "SUP-341029", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 154.59, "maximum": 931.28, "setting": "outpatient", "gross_charge": 931.28, "discounted_cash": 651.9, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 745.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 745.02, "10th_percentile": 745.02, "90th_percentile": 745.02, "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": 745.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 745.02, "10th_percentile": 745.02, "90th_percentile": 745.02, "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": 197.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 197.34, "10th_percentile": 197.34, "90th_percentile": 197.34, "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 HMO", "standard_charge_dollar": 197.34, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 197.34, "10th_percentile": 197.34, "90th_percentile": 197.34, "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": 254.33, "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": 254.33, "10th_percentile": 254.33, "90th_percentile": 254.33, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 254.33, "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": 254.33, "10th_percentile": 254.33, "90th_percentile": 254.33, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 931.28, "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 $931.28 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "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 $931.28 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": 204.97, "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": 204.97, "10th_percentile": 204.97, "90th_percentile": 204.97, "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": 195.2, "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": 195.2, "10th_percentile": 195.2, "90th_percentile": 195.2, "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": 216.71, "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": 216.71, "10th_percentile": 216.71, "90th_percentile": 216.71, "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": 419.08, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 419.08, "10th_percentile": 419.08, "90th_percentile": 419.08, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 465.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 465.64, "10th_percentile": 465.64, "90th_percentile": 465.64, "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", "standard_charge_dollar": 400.45, "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": 400.45, "10th_percentile": 400.45, "90th_percentile": 400.45, "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": 154.59, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 154.59, "10th_percentile": 154.59, "90th_percentile": 154.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 838.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 838.15, "10th_percentile": 838.15, "90th_percentile": 838.15, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 595.09, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 595.09, "10th_percentile": 595.09, "90th_percentile": 595.09, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 763.65, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 763.65, "10th_percentile": 763.65, "90th_percentile": 763.65, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 452.6, "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": 452.6, "10th_percentile": 452.6, "90th_percentile": 452.6, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 441.43, "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": 441.43, "10th_percentile": 441.43, "90th_percentile": 441.43, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 931.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 598.16, "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": 598.16, "10th_percentile": 598.16, "90th_percentile": 598.16, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 931.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 195.57, "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": 195.57, "10th_percentile": 195.57, "90th_percentile": 195.57, "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 ASA", "standard_charge_dollar": 423.73, "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": 423.73, "10th_percentile": 423.73, "90th_percentile": 423.73, "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": 490.78, "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": 490.78, "10th_percentile": 490.78, "90th_percentile": 490.78, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "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": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "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": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "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": 931.28, "10th_percentile": 931.28, "90th_percentile": 931.28, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE KNIFE RETRACTABLE CANNULATED", "code_information": [ { "code": "SUP-347197", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 291.12, "maximum": 1753.72, "setting": "outpatient", "gross_charge": 1753.72, "discounted_cash": 1227.6, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 478.94, "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": 478.94, "10th_percentile": 478.94, "90th_percentile": 478.94, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 478.94, "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": 478.94, "10th_percentile": 478.94, "90th_percentile": 478.94, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 371.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 371.61, "10th_percentile": 371.61, "90th_percentile": 371.61, "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 HMO", "standard_charge_dollar": 371.61, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 371.61, "10th_percentile": 371.61, "90th_percentile": 371.61, "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": 1402.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1402.98, "10th_percentile": 1402.98, "90th_percentile": 1402.98, "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": 1402.98, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1402.98, "10th_percentile": 1402.98, "90th_percentile": 1402.98, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1753.72, "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 $1,753.72 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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 $1,753.72 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 BCBS BLUECHOICE OPTIONS", "standard_charge_dollar": 408.09, "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": 408.09, "10th_percentile": 408.09, "90th_percentile": 408.09, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 385.99, "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": 385.99, "10th_percentile": 385.99, "90th_percentile": 385.99, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 789.17, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 789.17, "10th_percentile": 789.17, "90th_percentile": 789.17, "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": 367.58, "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": 367.58, "10th_percentile": 367.58, "90th_percentile": 367.58, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1578.35, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1578.35, "10th_percentile": 1578.35, "90th_percentile": 1578.35, "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": 876.86, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 876.86, "10th_percentile": 876.86, "90th_percentile": 876.86, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1438.05, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1438.05, "10th_percentile": 1438.05, "90th_percentile": 1438.05, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 852.31, "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": 852.31, "10th_percentile": 852.31, "90th_percentile": 852.31, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1753.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1120.63, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1120.63, "10th_percentile": 1120.63, "90th_percentile": 1120.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1753.72, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 291.12, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 291.12, "10th_percentile": 291.12, "90th_percentile": 291.12, "count": "0", "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": 1126.41, "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": 1126.41, "10th_percentile": 1126.41, "90th_percentile": 1126.41, "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": 924.21, "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": 924.21, "10th_percentile": 924.21, "90th_percentile": 924.21, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 831.26, "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": 831.26, "10th_percentile": 831.26, "90th_percentile": 831.26, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 368.28, "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": 368.28, "10th_percentile": 368.28, "90th_percentile": 368.28, "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": 754.1, "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": 754.1, "10th_percentile": 754.1, "90th_percentile": 754.1, "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 ASA", "standard_charge_dollar": 797.94, "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": 797.94, "10th_percentile": 797.94, "90th_percentile": 797.94, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "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": 1753.72, "10th_percentile": 1753.72, "90th_percentile": 1753.72, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE LIGHTED RETRACTOR BRITEFIELD WAVEGUDE 104015", "code_information": [ { "code": "SUP-353169", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 708.32, "maximum": 4266.96, "setting": "outpatient", "gross_charge": 4266.96, "discounted_cash": 2986.87, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1165.31, "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": 1165.31, "10th_percentile": 1165.31, "90th_percentile": 1165.31, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1165.31, "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": 1165.31, "10th_percentile": 1165.31, "90th_percentile": 1165.31, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 904.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 904.17, "10th_percentile": 904.17, "90th_percentile": 904.17, "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 HMO", "standard_charge_dollar": 904.17, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 904.17, "10th_percentile": 904.17, "90th_percentile": 904.17, "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": 3413.57, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3413.57, "10th_percentile": 3413.57, "90th_percentile": 3413.57, "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": 3413.57, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3413.57, "10th_percentile": 3413.57, "90th_percentile": 3413.57, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 4266.96, "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 $4,266.96 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "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 $4,266.96 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": 992.92, "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": 992.92, "10th_percentile": 992.92, "90th_percentile": 992.92, "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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 939.16, "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": 939.16, "10th_percentile": 939.16, "90th_percentile": 939.16, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 1920.13, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 1920.13, "10th_percentile": 1920.13, "90th_percentile": 1920.13, "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": 894.35, "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": 894.35, "10th_percentile": 894.35, "90th_percentile": 894.35, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3840.26, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3840.26, "10th_percentile": 3840.26, "90th_percentile": 3840.26, "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": 2133.48, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2133.48, "10th_percentile": 2133.48, "90th_percentile": 2133.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3498.91, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 3498.91, "10th_percentile": 3498.91, "90th_percentile": 3498.91, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 2073.74, "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": 2073.74, "10th_percentile": 2073.74, "90th_percentile": 2073.74, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4266.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 2726.59, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2726.59, "10th_percentile": 2726.59, "90th_percentile": 2726.59, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4266.96, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 708.32, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 708.32, "10th_percentile": 708.32, "90th_percentile": 708.32, "count": "0", "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": 2740.67, "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": 2740.67, "10th_percentile": 2740.67, "90th_percentile": 2740.67, "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": 2248.69, "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": 2248.69, "10th_percentile": 2248.69, "90th_percentile": 2248.69, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2022.54, "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": 2022.54, "10th_percentile": 2022.54, "90th_percentile": 2022.54, "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": 896.06, "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": 896.06, "10th_percentile": 896.06, "90th_percentile": 896.06, "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": 1834.79, "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": 1834.79, "10th_percentile": 1834.79, "90th_percentile": 1834.79, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1941.47, "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": 1941.47, "10th_percentile": 1941.47, "90th_percentile": 1941.47, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "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": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "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": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "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": 4266.96, "10th_percentile": 4266.96, "90th_percentile": 4266.96, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE RADENOID PEDIATRIC ENT 40DEG 4MM 1884008", "code_information": [ { "code": "SUP-310356", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 250.94, "maximum": 1511.69, "setting": "outpatient", "gross_charge": 1511.69, "discounted_cash": 1058.18, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1209.35, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1209.35, "10th_percentile": 1209.35, "90th_percentile": 1209.35, "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": 1209.35, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1209.35, "10th_percentile": 1209.35, "90th_percentile": 1209.35, "count": "0", "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": 412.84, "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": 412.84, "10th_percentile": 412.84, "90th_percentile": 412.84, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 412.84, "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": 412.84, "10th_percentile": 412.84, "90th_percentile": 412.84, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 320.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 320.33, "10th_percentile": 320.33, "90th_percentile": 320.33, "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 HMO", "standard_charge_dollar": 320.33, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 320.33, "10th_percentile": 320.33, "90th_percentile": 320.33, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1511.69, "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 $1,511.69 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "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 $1,511.69 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": 332.72, "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": 332.72, "10th_percentile": 332.72, "90th_percentile": 332.72, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 680.26, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 680.26, "10th_percentile": 680.26, "90th_percentile": 680.26, "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 OPTIONS", "standard_charge_dollar": 351.77, "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": 351.77, "10th_percentile": 351.77, "90th_percentile": 351.77, "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 BLUECHOICE SELECT", "standard_charge_dollar": 316.85, "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": 316.85, "10th_percentile": 316.85, "90th_percentile": 316.85, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 970.96, "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": 970.96, "10th_percentile": 970.96, "90th_percentile": 970.96, "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 BROAD", "standard_charge_dollar": 734.68, "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": 734.68, "10th_percentile": 734.68, "90th_percentile": 734.68, "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": 1239.59, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1239.59, "10th_percentile": 1239.59, "90th_percentile": 1239.59, "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": 755.85, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 755.85, "10th_percentile": 755.85, "90th_percentile": 755.85, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1511.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 250.94, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 250.94, "10th_percentile": 250.94, "90th_percentile": 250.94, "count": "0", "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": 716.54, "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": 716.54, "10th_percentile": 716.54, "90th_percentile": 716.54, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 687.82, "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": 687.82, "10th_percentile": 687.82, "90th_percentile": 687.82, "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": 796.66, "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": 796.66, "10th_percentile": 796.66, "90th_percentile": 796.66, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1511.69, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 317.45, "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": 317.45, "10th_percentile": 317.45, "90th_percentile": 317.45, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 965.97, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 965.97, "10th_percentile": 965.97, "90th_percentile": 965.97, "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": 650.03, "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": 650.03, "10th_percentile": 650.03, "90th_percentile": 650.03, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1360.52, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1360.52, "10th_percentile": 1360.52, "90th_percentile": 1360.52, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "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": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "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": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "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": 1511.69, "10th_percentile": 1511.69, "90th_percentile": 1511.69, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE SAGITTAL 14X41X0.4MM 5023-133", "code_information": [ { "code": "SUP-317176", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 13.49, "maximum": 81.28, "setting": "outpatient", "gross_charge": 81.28, "discounted_cash": 56.9, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 65.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 65.02, "10th_percentile": 65.02, "90th_percentile": 65.02, "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": 65.02, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 65.02, "10th_percentile": 65.02, "90th_percentile": 65.02, "count": "0", "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": 22.2, "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": 22.2, "10th_percentile": 22.2, "90th_percentile": 22.2, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 22.2, "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": 22.2, "10th_percentile": 22.2, "90th_percentile": 22.2, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 17.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 17.22, "10th_percentile": 17.22, "90th_percentile": 17.22, "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 HMO", "standard_charge_dollar": 17.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 17.22, "10th_percentile": 17.22, "90th_percentile": 17.22, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 81.28, "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 $81.28 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "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 $81.28 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": 17.89, "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": 17.89, "10th_percentile": 17.89, "90th_percentile": 17.89, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 36.58, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 36.58, "10th_percentile": 36.58, "90th_percentile": 36.58, "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 OPTIONS", "standard_charge_dollar": 18.91, "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": 18.91, "10th_percentile": 18.91, "90th_percentile": 18.91, "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 BLUECHOICE SELECT", "standard_charge_dollar": 17.04, "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": 17.04, "10th_percentile": 17.04, "90th_percentile": 17.04, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 52.21, "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": 52.21, "10th_percentile": 52.21, "90th_percentile": 52.21, "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 BROAD", "standard_charge_dollar": 39.5, "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": 39.5, "10th_percentile": 39.5, "90th_percentile": 39.5, "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": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 66.65, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 66.65, "10th_percentile": 66.65, "90th_percentile": 66.65, "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": 40.64, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 40.64, "10th_percentile": 40.64, "90th_percentile": 40.64, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 81.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 13.49, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 13.49, "10th_percentile": 13.49, "90th_percentile": 13.49, "count": "0", "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": 38.53, "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": 38.53, "10th_percentile": 38.53, "90th_percentile": 38.53, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 36.98, "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": 36.98, "10th_percentile": 36.98, "90th_percentile": 36.98, "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": 42.83, "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": 42.83, "10th_percentile": 42.83, "90th_percentile": 42.83, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 81.28, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 17.07, "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": 17.07, "10th_percentile": 17.07, "90th_percentile": 17.07, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 51.94, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 51.94, "10th_percentile": 51.94, "90th_percentile": 51.94, "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": 34.95, "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": 34.95, "10th_percentile": 34.95, "90th_percentile": 34.95, "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": 73.15, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 73.15, "10th_percentile": 73.15, "90th_percentile": 73.15, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "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": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "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": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "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": 81.28, "10th_percentile": 81.28, "90th_percentile": 81.28, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE SHAVER 2.9MM 7CM POWERMINI ABRADER DISPO", "code_information": [ { "code": "SUP-404136", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 82.42, "maximum": 496.48, "setting": "outpatient", "gross_charge": 496.48, "discounted_cash": 347.54, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 397.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 397.18, "10th_percentile": 397.18, "90th_percentile": 397.18, "count": "0", "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": 135.59, "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": 135.59, "10th_percentile": 135.59, "90th_percentile": 135.59, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 135.59, "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": 135.59, "10th_percentile": 135.59, "90th_percentile": 135.59, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 105.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 105.2, "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 HMO", "standard_charge_dollar": 105.2, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 105.2, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 496.48, "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 $496.48 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "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 $496.48 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 109.28, "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": 109.28, "10th_percentile": 109.28, "90th_percentile": 109.28, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 223.42, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 223.42, "10th_percentile": 223.42, "90th_percentile": 223.42, "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 OPTIONS", "standard_charge_dollar": 115.53, "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": 115.53, "10th_percentile": 115.53, "90th_percentile": 115.53, "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 BLUECHOICE SELECT", "standard_charge_dollar": 104.06, "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": 104.06, "10th_percentile": 104.06, "90th_percentile": 104.06, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 241.29, "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": 241.29, "10th_percentile": 241.29, "90th_percentile": 241.29, "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": 407.11, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 407.11, "10th_percentile": 407.11, "90th_percentile": 407.11, "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": 248.24, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 248.24, "10th_percentile": 248.24, "90th_percentile": 248.24, "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": 82.42, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 82.42, "10th_percentile": 82.42, "90th_percentile": 82.42, "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 ASA", "standard_charge_dollar": 225.9, "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": 225.9, "10th_percentile": 225.9, "90th_percentile": 225.9, "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": 104.26, "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": 104.26, "10th_percentile": 104.26, "90th_percentile": 104.26, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 317.25, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 317.25, "10th_percentile": 317.25, "90th_percentile": 317.25, "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": 213.49, "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": 213.49, "10th_percentile": 213.49, "90th_percentile": 213.49, "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": 446.83, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 446.83, "10th_percentile": 446.83, "90th_percentile": 446.83, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "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": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "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": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "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": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "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": 397.18, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 397.18, "10th_percentile": 397.18, "90th_percentile": 397.18, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 496.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 496.48, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 496.48, "10th_percentile": 496.48, "90th_percentile": 496.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 318.89, "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": 318.89, "10th_percentile": 318.89, "90th_percentile": 318.89, "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": 261.64, "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": 261.64, "10th_percentile": 261.64, "90th_percentile": 261.64, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 235.33, "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": 235.33, "10th_percentile": 235.33, "90th_percentile": 235.33, "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." } ] } ] }, { "description": "BLADE SHAVER CURVED CONCAVE FULL RAD 3.5 7210980", "code_information": [ { "code": "SUP-166275", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 62.46, "maximum": 376.26, "setting": "outpatient", "gross_charge": 376.26, "discounted_cash": 263.38, "payers_information": [ { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 301.01, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 301.01, "10th_percentile": 301.01, "90th_percentile": 301.01, "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": 301.01, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 301.01, "10th_percentile": 301.01, "90th_percentile": 301.01, "count": "0", "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": 102.76, "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": 102.76, "10th_percentile": 102.76, "90th_percentile": 102.76, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 102.76, "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": 102.76, "10th_percentile": 102.76, "90th_percentile": 102.76, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 79.73, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 79.73, "10th_percentile": 79.73, "90th_percentile": 79.73, "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 HMO", "standard_charge_dollar": 79.73, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 79.73, "10th_percentile": 79.73, "90th_percentile": 79.73, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 376.26, "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 $376.26 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "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 $376.26 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 82.81, "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": 82.81, "10th_percentile": 82.81, "90th_percentile": 82.81, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 169.32, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 169.32, "10th_percentile": 169.32, "90th_percentile": 169.32, "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 OPTIONS", "standard_charge_dollar": 87.56, "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": 87.56, "10th_percentile": 87.56, "90th_percentile": 87.56, "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 BLUECHOICE SELECT", "standard_charge_dollar": 78.86, "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": 78.86, "10th_percentile": 78.86, "90th_percentile": 78.86, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 241.67, "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": 241.67, "10th_percentile": 241.67, "90th_percentile": 241.67, "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 BROAD", "standard_charge_dollar": 182.86, "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": 182.86, "10th_percentile": 182.86, "90th_percentile": 182.86, "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": 308.53, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 308.53, "10th_percentile": 308.53, "90th_percentile": 308.53, "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": 188.13, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 188.13, "10th_percentile": 188.13, "90th_percentile": 188.13, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 376.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 62.46, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 62.46, "10th_percentile": 62.46, "90th_percentile": 62.46, "count": "0", "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": 178.35, "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": 178.35, "10th_percentile": 178.35, "90th_percentile": 178.35, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 171.2, "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": 171.2, "10th_percentile": 171.2, "90th_percentile": 171.2, "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": 198.29, "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": 198.29, "10th_percentile": 198.29, "90th_percentile": 198.29, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 376.26, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 79.01, "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": 79.01, "10th_percentile": 79.01, "90th_percentile": 79.01, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 240.43, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 240.43, "10th_percentile": 240.43, "90th_percentile": 240.43, "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": 161.79, "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": 161.79, "10th_percentile": 161.79, "90th_percentile": 161.79, "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": 338.63, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 338.63, "10th_percentile": 338.63, "90th_percentile": 338.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "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": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "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": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "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": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "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": 376.26, "10th_percentile": 376.26, "90th_percentile": 376.26, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE SHAVER TURBINATE BIPOLAR DIEGO 2MM", "code_information": [ { "code": "SUP-347416", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 233.45, "maximum": 1406.31, "setting": "outpatient", "gross_charge": 1406.31, "discounted_cash": 984.42, "payers_information": [ { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 384.06, "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": 384.06, "10th_percentile": 384.06, "90th_percentile": 384.06, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 384.06, "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": 384.06, "10th_percentile": 384.06, "90th_percentile": 384.06, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 298.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 298.0, "10th_percentile": 298.0, "90th_percentile": 298.0, "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 HMO", "standard_charge_dollar": 298.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 298.0, "10th_percentile": 298.0, "90th_percentile": 298.0, "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": 1125.05, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1125.05, "10th_percentile": 1125.05, "90th_percentile": 1125.05, "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": 1125.05, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1125.05, "10th_percentile": 1125.05, "90th_percentile": 1125.05, "count": "0", "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1406.31, "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 $1,406.31 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "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 $1,406.31 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": 327.25, "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": 327.25, "10th_percentile": 327.25, "90th_percentile": 327.25, "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 BLUECHOICE PREFERRED", "standard_charge_dollar": 309.53, "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": 309.53, "10th_percentile": 309.53, "90th_percentile": 309.53, "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 BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 632.84, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 632.84, "10th_percentile": 632.84, "90th_percentile": 632.84, "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 BLUECHOICE SELECT", "standard_charge_dollar": 294.76, "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": 294.76, "10th_percentile": 294.76, "90th_percentile": 294.76, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1265.68, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1265.68, "10th_percentile": 1265.68, "90th_percentile": 1265.68, "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": 703.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 703.16, "10th_percentile": 703.16, "90th_percentile": 703.16, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Outpatient Services; 50% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1153.17, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1153.17, "10th_percentile": 1153.17, "90th_percentile": 1153.17, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 683.47, "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": 683.47, "10th_percentile": 683.47, "90th_percentile": 683.47, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1406.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 898.63, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 898.63, "10th_percentile": 898.63, "90th_percentile": 898.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1406.31, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 233.45, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 233.45, "10th_percentile": 233.45, "90th_percentile": 233.45, "count": "0", "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": 903.27, "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": 903.27, "10th_percentile": 903.27, "90th_percentile": 903.27, "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": 741.13, "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": 741.13, "10th_percentile": 741.13, "90th_percentile": 741.13, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 666.59, "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": 666.59, "10th_percentile": 666.59, "90th_percentile": 666.59, "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": 295.33, "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": 295.33, "10th_percentile": 295.33, "90th_percentile": 295.33, "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": 604.71, "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": 604.71, "10th_percentile": 604.71, "90th_percentile": 604.71, "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 ASA", "standard_charge_dollar": 639.87, "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": 639.87, "10th_percentile": 639.87, "90th_percentile": 639.87, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "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": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "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": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "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": 1406.31, "10th_percentile": 1406.31, "90th_percentile": 1406.31, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE SHVR 4MM RD PLTNM FLYR FR ARTHRSCPC RSCTN DYNCS", "code_information": [ { "code": "SUP-436184", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 307.8, "maximum": 1854.21, "setting": "outpatient", "gross_charge": 1854.21, "discounted_cash": 1297.95, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1483.37, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1483.37, "10th_percentile": 1483.37, "90th_percentile": 1483.37, "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": 1483.37, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1483.37, "10th_percentile": 1483.37, "90th_percentile": 1483.37, "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": 392.91, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 392.91, "10th_percentile": 392.91, "90th_percentile": 392.91, "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 HMO", "standard_charge_dollar": 392.91, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 392.91, "10th_percentile": 392.91, "90th_percentile": 392.91, "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": 506.38, "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": 506.38, "10th_percentile": 506.38, "90th_percentile": 506.38, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 506.38, "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": 506.38, "10th_percentile": 506.38, "90th_percentile": 506.38, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 1854.21, "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 $1,854.21 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "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 $1,854.21 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": 408.11, "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": 408.11, "10th_percentile": 408.11, "90th_percentile": 408.11, "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": 388.64, "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": 388.64, "10th_percentile": 388.64, "90th_percentile": 388.64, "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": 431.47, "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": 431.47, "10th_percentile": 431.47, "90th_percentile": 431.47, "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": 834.39, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 834.39, "10th_percentile": 834.39, "90th_percentile": 834.39, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 927.11, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 927.11, "10th_percentile": 927.11, "90th_percentile": 927.11, "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", "standard_charge_dollar": 797.31, "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": 797.31, "10th_percentile": 797.31, "90th_percentile": 797.31, "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": 307.8, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 307.8, "10th_percentile": 307.8, "90th_percentile": 307.8, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1668.79, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1668.79, "10th_percentile": 1668.79, "90th_percentile": 1668.79, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1184.84, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1184.84, "10th_percentile": 1184.84, "90th_percentile": 1184.84, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1520.45, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1520.45, "10th_percentile": 1520.45, "90th_percentile": 1520.45, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 901.15, "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": 901.15, "10th_percentile": 901.15, "90th_percentile": 901.15, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 878.9, "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": 878.9, "10th_percentile": 878.9, "90th_percentile": 878.9, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1854.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1190.96, "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": 1190.96, "10th_percentile": 1190.96, "90th_percentile": 1190.96, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1854.21, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 389.38, "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": 389.38, "10th_percentile": 389.38, "90th_percentile": 389.38, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 843.67, "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": 843.67, "10th_percentile": 843.67, "90th_percentile": 843.67, "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": 977.17, "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": 977.17, "10th_percentile": 977.17, "90th_percentile": 977.17, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "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": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "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": 1854.21, "10th_percentile": 1854.21, "90th_percentile": 1854.21, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLADE SW 90X19.5X1.27MM INTREX", "code_information": [ { "code": "SUP-394016", "type": "CDM" }, { "code": "27200001", "type": "LOCAL" }, { "code": "0272", "type": "RC" } ], "standard_charges": [ { "minimum": 264.99, "maximum": 1596.32, "setting": "outpatient", "gross_charge": 1596.32, "discounted_cash": 1117.42, "payers_information": [ { "payer_name": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 1277.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1277.06, "10th_percentile": 1277.06, "90th_percentile": 1277.06, "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": 1277.06, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 1277.06, "10th_percentile": 1277.06, "90th_percentile": 1277.06, "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": 338.26, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 338.26, "10th_percentile": 338.26, "90th_percentile": 338.26, "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 HMO", "standard_charge_dollar": 338.26, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 338.26, "10th_percentile": 338.26, "90th_percentile": 338.26, "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": 435.95, "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": 435.95, "10th_percentile": 435.95, "90th_percentile": 435.95, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 435.95, "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": 435.95, "10th_percentile": 435.95, "90th_percentile": 435.95, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 1596.32, "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 $1,596.32 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "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 $1,596.32 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 BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 351.35, "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": 351.35, "10th_percentile": 351.35, "90th_percentile": 351.35, "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": 334.59, "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": 334.59, "10th_percentile": 334.59, "90th_percentile": 334.59, "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": 371.46, "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": 371.46, "10th_percentile": 371.46, "90th_percentile": 371.46, "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": 718.34, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 718.34, "10th_percentile": 718.34, "90th_percentile": 718.34, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 798.16, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 798.16, "10th_percentile": 798.16, "90th_percentile": 798.16, "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", "standard_charge_dollar": 686.42, "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": 686.42, "10th_percentile": 686.42, "90th_percentile": 686.42, "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": 264.99, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 264.99, "10th_percentile": 264.99, "90th_percentile": 264.99, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Services; 16.6% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 1436.69, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 1436.69, "10th_percentile": 1436.69, "90th_percentile": 1436.69, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 1020.05, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 1020.05, "10th_percentile": 1020.05, "90th_percentile": 1020.05, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 1308.98, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 1308.98, "10th_percentile": 1308.98, "90th_percentile": 1308.98, "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": "NLFH CIGNA BROAD", "standard_charge_dollar": 775.81, "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": 775.81, "10th_percentile": 775.81, "90th_percentile": 775.81, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 756.66, "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": 756.66, "10th_percentile": 756.66, "90th_percentile": 756.66, "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": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 1596.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 1025.32, "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": 1025.32, "10th_percentile": 1025.32, "90th_percentile": 1025.32, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 1596.32, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA ALTERNATIVE", "standard_charge_dollar": 335.23, "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": 335.23, "10th_percentile": 335.23, "90th_percentile": 335.23, "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 ASA", "standard_charge_dollar": 726.33, "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": 726.33, "10th_percentile": 726.33, "90th_percentile": 726.33, "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": 841.26, "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": 841.26, "10th_percentile": 841.26, "90th_percentile": 841.26, "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": "HUMANA HEALTH PLAN [130]", "plan_name": "NLFH ADVOCATE IPA", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "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": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "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": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "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": 1596.32, "10th_percentile": 1596.32, "90th_percentile": 1596.32, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLANKET INTOP UPPR BDY BAIR HGGR MUL-POSITION 78X24IN", "code_information": [ { "code": "SUP-337798", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 9.03, "maximum": 54.37, "setting": "outpatient", "gross_charge": 54.37, "discounted_cash": 38.06, "payers_information": [ { "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": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "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": 43.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 43.5, "10th_percentile": 43.5, "90th_percentile": 43.5, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All Other Procedure; 80% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 54.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 54.37, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 34.74, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 34.74, "10th_percentile": 34.74, "90th_percentile": 34.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 27.19, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 27.19, "10th_percentile": 27.19, "90th_percentile": 27.19, "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": 48.93, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 48.93, "10th_percentile": 48.93, "90th_percentile": 48.93, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Procedures; 90% Billed" }, { "payer_name": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 34.92, "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": 34.92, "10th_percentile": 34.92, "90th_percentile": 34.92, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 25.77, "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": 25.77, "10th_percentile": 25.77, "90th_percentile": 25.77, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 28.65, "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": 28.65, "10th_percentile": 28.65, "90th_percentile": 28.65, "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": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "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": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "count": "0", "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": 43.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 43.5, "10th_percentile": 43.5, "90th_percentile": 43.5, "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 HMO", "standard_charge_dollar": 11.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 11.52, "10th_percentile": 11.52, "90th_percentile": 11.52, "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 HMO", "standard_charge_dollar": 11.52, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 11.52, "10th_percentile": 11.52, "90th_percentile": 11.52, "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 PAR/INDEMNITY ADP", "standard_charge_dollar": 54.37, "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 $54.37 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 54.37, "10th_percentile": 54.37, "90th_percentile": 54.37, "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 $54.37 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": 24.47, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 24.47, "10th_percentile": 24.47, "90th_percentile": 24.47, "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 PREFERRED", "standard_charge_dollar": 11.97, "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": 11.97, "10th_percentile": 11.97, "90th_percentile": 11.97, "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": 12.65, "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": 12.65, "10th_percentile": 12.65, "90th_percentile": 12.65, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 9.03, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 9.03, "10th_percentile": 9.03, "90th_percentile": 9.03, "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 ALTERNATIVE", "standard_charge_dollar": 11.42, "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": 11.42, "10th_percentile": 11.42, "90th_percentile": 11.42, "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": 23.38, "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": 23.38, "10th_percentile": 23.38, "90th_percentile": 23.38, "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": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 26.42, "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": 26.42, "10th_percentile": 26.42, "90th_percentile": 26.42, "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": 44.58, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 44.58, "10th_percentile": 44.58, "90th_percentile": 44.58, "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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 11.4, "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": 11.4, "10th_percentile": 11.4, "90th_percentile": 11.4, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 24.74, "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": 24.74, "10th_percentile": 24.74, "90th_percentile": 24.74, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 14.85, "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": 14.85, "10th_percentile": 14.85, "90th_percentile": 14.85, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 14.85, "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": 14.85, "10th_percentile": 14.85, "90th_percentile": 14.85, "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." } ] } ] }, { "description": "BLANKET UNDRBYD BAIR HGGR PED", "code_information": [ { "code": "SUP-7305", "type": "CDM" }, { "code": "27103350", "type": "LOCAL" }, { "code": "0271", "type": "RC" } ], "standard_charges": [ { "minimum": 52.86, "maximum": 318.44, "setting": "outpatient", "gross_charge": 318.44, "discounted_cash": 222.91, "payers_information": [ { "payer_name": "GLOBAL EXCEL [1712]", "plan_name": "NLFH MEDICARE", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "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": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "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", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "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": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "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": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "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": 254.75, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 254.75, "10th_percentile": 254.75, "90th_percentile": 254.75, "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": 254.75, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 254.75, "10th_percentile": 254.75, "90th_percentile": 254.75, "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": 67.48, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 67.48, "10th_percentile": 67.48, "90th_percentile": 67.48, "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 HMO", "standard_charge_dollar": 67.48, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 67.48, "10th_percentile": 67.48, "90th_percentile": 67.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 318.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 318.44, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 318.44, "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 $318.44 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 318.44, "10th_percentile": 318.44, "90th_percentile": 318.44, "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 $318.44 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 159.22, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 159.22, "10th_percentile": 159.22, "90th_percentile": 159.22, "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": 286.6, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 286.6, "10th_percentile": 286.6, "90th_percentile": 286.6, "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": "NLFH HFN PLATINUM/CHC ELITE", "standard_charge_dollar": 203.48, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 203.48, "10th_percentile": 203.48, "90th_percentile": 203.48, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 143.3, "standard_charge_percentage": 45.0, "standard_charge_algorithm": "IPA OP Services; 45% Billed", "median_amount": 143.3, "10th_percentile": 143.3, "90th_percentile": 143.3, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "IPA OP Services; 45% Billed" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 150.94, "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": 150.94, "10th_percentile": 150.94, "90th_percentile": 150.94, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE PREFERRED", "standard_charge_dollar": 70.09, "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": 70.09, "10th_percentile": 70.09, "90th_percentile": 70.09, "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": 74.1, "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": 74.1, "10th_percentile": 74.1, "90th_percentile": 74.1, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 204.53, "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": 204.53, "10th_percentile": 204.53, "90th_percentile": 204.53, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 52.86, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 52.86, "10th_percentile": 52.86, "90th_percentile": 52.86, "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 ALTERNATIVE", "standard_charge_dollar": 66.87, "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": 66.87, "10th_percentile": 66.87, "90th_percentile": 66.87, "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": 136.93, "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": 136.93, "10th_percentile": 136.93, "90th_percentile": 136.93, "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 BROAD", "standard_charge_dollar": 154.76, "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": 154.76, "10th_percentile": 154.76, "90th_percentile": 154.76, "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": 261.12, "standard_charge_percentage": 82.0, "standard_charge_algorithm": "No historical claim; All Other OP; 82% Billed", "median_amount": 261.12, "10th_percentile": 261.12, "90th_percentile": 261.12, "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": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 66.75, "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": 66.75, "10th_percentile": 66.75, "90th_percentile": 66.75, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 144.89, "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": 144.89, "10th_percentile": 144.89, "90th_percentile": 144.89, "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": 167.82, "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": 167.82, "10th_percentile": 167.82, "90th_percentile": 167.82, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 86.97, "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": 86.97, "10th_percentile": 86.97, "90th_percentile": 86.97, "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": "ALTERNATE BLUE CROSS [1402]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 86.97, "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": 86.97, "10th_percentile": 86.97, "90th_percentile": 86.97, "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." } ] } ] }, { "description": "BLDE HEL CANN 11X100MM TI STRL", "code_information": [ { "code": "SUP-3054", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 816.98, "maximum": 4921.58, "setting": "outpatient", "gross_charge": 4921.58, "discounted_cash": 3445.11, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 816.98, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2391.89, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2593.67, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1151.65, "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": 1151.65, "10th_percentile": 1151.65, "90th_percentile": 1151.65, "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": 1151.65, "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": 1151.65, "10th_percentile": 1151.65, "90th_percentile": 1151.65, "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": 1151.65, "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": 1151.65, "10th_percentile": 1151.65, "90th_percentile": 1151.65, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3937.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3937.26, "10th_percentile": 3937.26, "90th_percentile": 3937.26, "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": 3937.26, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3937.26, "10th_percentile": 3937.26, "90th_percentile": 3937.26, "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": 1343.59, "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": 1343.59, "10th_percentile": 1343.59, "90th_percentile": 1343.59, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1343.59, "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": 1343.59, "10th_percentile": 1343.59, "90th_percentile": 1343.59, "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 HMO", "standard_charge_dollar": 1042.88, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1042.88, "10th_percentile": 1042.88, "90th_percentile": 1042.88, "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 HMO", "standard_charge_dollar": 1042.88, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1042.88, "10th_percentile": 1042.88, "90th_percentile": 1042.88, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4921.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4921.58, "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 $4,921.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "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 $4,921.58 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4921.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4921.58, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 2116.28, "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": 2116.28, "10th_percentile": 2116.28, "90th_percentile": 2116.28, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 2332.83, "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": 2332.83, "10th_percentile": 2332.83, "90th_percentile": 2332.83, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 2239.32, "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": 2239.32, "10th_percentile": 2239.32, "90th_percentile": 2239.32, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 3161.13, "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": 3161.13, "10th_percentile": 3161.13, "90th_percentile": 3161.13, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 4429.42, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 4429.42, "10th_percentile": 4429.42, "90th_percentile": 4429.42, "count": "0", "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": 1033.53, "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": 1033.53, "10th_percentile": 1033.53, "90th_percentile": 1033.53, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2460.79, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2460.79, "10th_percentile": 2460.79, "90th_percentile": 2460.79, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 3144.89, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 3144.89, "10th_percentile": 3144.89, "90th_percentile": 3144.89, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3789.62, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3789.62, "10th_percentile": 3789.62, "90th_percentile": 3789.62, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $4,921.58 @ 12.8% = $629.96 due to $0.00 Claim Price", "median_amount": 629.96, "10th_percentile": 629.96, "90th_percentile": 629.96, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,921.58 @ 12.8% = $629.96 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "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": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "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": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "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": 4921.58, "10th_percentile": 4921.58, "90th_percentile": 4921.58, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLDE HEL CANN 11X80MM TI", "code_information": [ { "code": "SUP-150117", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 684.85, "maximum": 4125.63, "setting": "outpatient", "gross_charge": 4125.63, "discounted_cash": 2887.94, "payers_information": [ { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 684.85, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2005.06, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2174.21, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 965.4, "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": 965.4, "10th_percentile": 965.4, "90th_percentile": 965.4, "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": 965.4, "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": 965.4, "10th_percentile": 965.4, "90th_percentile": 965.4, "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": 965.4, "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": 965.4, "10th_percentile": 965.4, "90th_percentile": 965.4, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 3300.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3300.5, "10th_percentile": 3300.5, "90th_percentile": 3300.5, "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": 3300.5, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 3300.5, "10th_percentile": 3300.5, "90th_percentile": 3300.5, "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": 1126.3, "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": 1126.3, "10th_percentile": 1126.3, "90th_percentile": 1126.3, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1126.3, "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": 1126.3, "10th_percentile": 1126.3, "90th_percentile": 1126.3, "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 HMO", "standard_charge_dollar": 874.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 874.22, "10th_percentile": 874.22, "90th_percentile": 874.22, "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 HMO", "standard_charge_dollar": 874.22, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 874.22, "10th_percentile": 874.22, "90th_percentile": 874.22, "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 NON-CONTRACTED OON - ED ONLY", "standard_charge_dollar": 4125.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services - OON; 100% Billed", "median_amount": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services - OON; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PAR/INDEMNITY ADP", "standard_charge_dollar": 4125.63, "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 $4,125.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount.", "median_amount": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "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 $4,125.63 so that total pmt for all claim lines does not exceed 100% of claim billed amount." }, { "payer_name": "MULTIPLAN/PHCS [142]", "plan_name": "NLFH NON-CONTRACTED PAYORS", "standard_charge_dollar": 4125.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "All OP Services; 100% Billed", "median_amount": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "All OP Services; 100% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BC LAKE COUNTY PHYS ASSOC IPA", "standard_charge_dollar": 4125.63, "standard_charge_percentage": 100.0, "standard_charge_algorithm": "BC PAY OBVS; 100% Billed", "median_amount": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "BC PAY OBVS; 100% Billed" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA", "standard_charge_dollar": 1774.02, "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": 1774.02, "10th_percentile": 1774.02, "90th_percentile": 1774.02, "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": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC CORE", "standard_charge_dollar": 1955.55, "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": 1955.55, "10th_percentile": 1955.55, "90th_percentile": 1955.55, "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": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA ASA", "standard_charge_dollar": 1877.16, "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": 1877.16, "10th_percentile": 1877.16, "90th_percentile": 1877.16, "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": "THE ALLIANCE [1703]", "plan_name": "NLFH THE ALLIANCE", "standard_charge_dollar": 2649.89, "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": 2649.89, "10th_percentile": 2649.89, "90th_percentile": 2649.89, "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": "HEALTH'S FINEST NETWORK [126]", "plan_name": "NLFH HFN PPO", "standard_charge_dollar": 3713.07, "standard_charge_percentage": 90.0, "standard_charge_algorithm": "All OP Procedures; 90% Billed", "median_amount": 3713.07, "10th_percentile": 3713.07, "90th_percentile": 3713.07, "count": "0", "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": 866.38, "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": 866.38, "10th_percentile": 866.38, "90th_percentile": 866.38, "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": "HEALTHLINK [125]", "plan_name": "NLFH SEIU HEALTHLINK", "standard_charge_dollar": 2062.82, "standard_charge_percentage": 50.0, "standard_charge_algorithm": "Outpatient Services; 50% Billed", "median_amount": 2062.82, "10th_percentile": 2062.82, "90th_percentile": 2062.82, "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 PLATINUM/CHC ELITE", "standard_charge_dollar": 2636.28, "standard_charge_percentage": 63.9, "standard_charge_algorithm": "OP Services; 63.9% Billed", "median_amount": 2636.28, "10th_percentile": 2636.28, "90th_percentile": 2636.28, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 63.9% Billed" }, { "payer_name": "FIRST HEALTH PLAN [6034]", "plan_name": "NLFH FIRST HEALTH", "standard_charge_dollar": 3176.74, "standard_charge_percentage": 77.0, "standard_charge_algorithm": "Implants/Orthotics; 77% Billed", "median_amount": 3176.74, "10th_percentile": 3176.74, "90th_percentile": 3176.74, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Implants/Orthotics; 77% 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: $4,125.63 @ 12.8% = $528.08 due to $0.00 Claim Price", "median_amount": 528.08, "10th_percentile": 528.08, "90th_percentile": 528.08, "count": "0", "methodology": "other", "additional_payer_notes": "APCs; 100% Billed, and; Pricing Extension - NLFH HB XR MULT PRICE 3M $0 RETURN & HAS APC FOR NLFH; Note: Multiple pricing methods applied. Percent of APC: $0.00 @ 100% = $0.00. Percent of Claim Billed: $4,125.63 @ 12.8% = $528.08 due to $0.00 Claim Price" }, { "payer_name": "ALTERNATE HUMANA MEDICARE ADV [2409]", "plan_name": "NLFH HUMANA MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" }, { "payer_name": "ALTERNATE BLUE CROSS MEDICARE ADV [2304]", "plan_name": "NLFH BLUE CROSS MEDICARE ADVT", "standard_charge_algorithm": "APC grouping requires price history; No contract line matched", "median_amount": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "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": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "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": 4125.63, "10th_percentile": 4125.63, "90th_percentile": 4125.63, "count": "0", "methodology": "other", "additional_payer_notes": "APC grouping requires price history; No contract line matched" } ] } ] }, { "description": "BLDE NL FEM RG NL-EX 100MM TI SPRL STRL", "code_information": [ { "code": "SUP-37410", "type": "CDM" }, { "code": "C1713", "type": "HCPCS" }, { "code": "0278", "type": "RC" } ], "standard_charges": [ { "minimum": 848.41, "maximum": 5110.88, "setting": "outpatient", "gross_charge": 5110.88, "discounted_cash": 3577.62, "payers_information": [ { "payer_name": "UNITED HEALTHCARE [158]", "plan_name": "NLFH UHC HMO/PPO", "standard_charge_dollar": 2693.43, "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": 1454.56, "10th_percentile": 1454.56, "90th_percentile": 1454.56, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "CIGNA HEALTH PLAN [178]", "plan_name": "NLFH CIGNA BROAD", "standard_charge_dollar": 2483.89, "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": 10499.7, "10th_percentile": 10499.7, "90th_percentile": 10499.7, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "AETNA HEALTH PLAN [171]", "plan_name": "NLFH AETNA NM EMPLOYEES", "standard_charge_dollar": 848.41, "standard_charge_percentage": 16.6, "standard_charge_algorithm": "All Services; 16.6% Billed", "median_amount": 974.26, "10th_percentile": 974.26, "90th_percentile": 974.26, "count": "1 through 10", "methodology": "percent of total billed charges" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS BLUECHOICE SELECT", "standard_charge_dollar": 1195.95, "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": 1195.95, "10th_percentile": 1195.95, "90th_percentile": 1195.95, "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": 1195.95, "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": 1195.95, "10th_percentile": 1195.95, "90th_percentile": 1195.95, "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": 1195.95, "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": 1195.95, "10th_percentile": 1195.95, "90th_percentile": 1195.95, "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": "BEECHSTREET [176]", "plan_name": "NLFH PHCS", "standard_charge_dollar": 4088.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4088.7, "10th_percentile": 4088.7, "90th_percentile": 4088.7, "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": 4088.7, "standard_charge_percentage": 80.0, "standard_charge_algorithm": "All Other Procedure; 80% Billed", "median_amount": 4088.7, "10th_percentile": 4088.7, "90th_percentile": 4088.7, "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": 1395.27, "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": 1395.27, "10th_percentile": 1395.27, "90th_percentile": 1395.27, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS PPO", "standard_charge_dollar": 1395.27, "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": 1395.27, "10th_percentile": 1395.27, "90th_percentile": 1395.27, "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": "BLUE CROSS BLUE SHIELD [1401]", "plan_name": "NLFH BCBS HMO", "standard_charge_dollar": 1083.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1083.0, "10th_percentile": 1083.0, "90th_percentile": 1083.0, "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": 1083.0, "standard_charge_percentage": 21.19, "standard_charge_algorithm": "OP Services; 21.19% Billed", "median_amount": 1083.0, "10th_percentile": 1083.0, "90th_percentile": 1083.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "OP Services; 21.19% Billed" }, { "payer_name": "BLUE CROSS BLUE SHIELD [1401]", "